VIVANT MEDICAL GROUP LLC (NPI# 1124652425) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124652425 |
| Entity Type | Organization |
| Organization Name | VIVANT MEDICAL GROUP LLC |
| Practice Address |
6214 Memorial Hwy Ste B Tampa FL 33615-4507 |
| Mailing Address |
15600 Hancock Rd Sarasota FL 34240-6701 |
| Practice Telephone | 8139245210 |
| Mailing Telephone | 8139245210 |
| Enumeration Date | 2020-02-25 |
| Last Update Date | 2020-11-03 |
| Authorized Official Name | DAPHNEE MOISE-JOHNSON (PRESIDENT) |
| Authorized Official Telephone | 8139245210 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 273932100 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 15600 Hancock Rd, Sarasota, FL 342406701 | 8139245210 |
| Street Address |
6214 MEMORIAL HWY STE B |
| City | TAMPA |
| State | FL |
| Zip Code | 33615-4507 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083125132 | The Ida House Assisted Living LLC | Assisted Living Facility | 6014 Rosewood Dr, Tampa, FL 33615 | 2017-10-17 |
| 1235671785 | Magnet Home Health Care Services, LLC | Home Health | 5700 Memorial Highway Suite G X H 102, Tampa, FL 33615 | 2016-11-15 |
| 1891247532 | Martin Esuzor | Nurse Practitioner | 7918 Hillsborough Avenue, Tampa, FL 33615 | 2016-10-28 |
| 1902263007 | Marie E. Simeon | Nursing Facility/Intermediate Care Facility | 8206 Pennywell Place, Tampa, FL 33615 | 2016-01-20 |
| 1598183659 | Mustafa Mohammad | Dermatology | 6001 Memorial Highway, Tampa, FL 33615 | 2014-04-04 |
| 1710327101 | Kelly A Alvarez | Case Manager/Care Coordinator | 7007 Cobblewood Ct, Tampa, FL 33615 | 2013-06-28 |
| 1336497080 | Serenity Home of Tampa Alf LLC | Assisted Living Facility | 6013 Cresthill Drive, Tampa, FL 33615 | 2012-08-28 |
| 1063777563 | Jaime Alexander Pacheco | Chiropractor | 6301 Memorial Hwy Suit 304, Tampa, FL 33615 | 2012-07-10 |
| 1558656678 | Scripts Direct, LLC | Pharmacy | 8313 W. Hillsborough Ave., # 260, Tampa, FL 33615 | 2011-06-16 |
| 1508178245 | The Spring of Tampa Bay | Counselor | 2810 N. 35 St, Tampa, FL 33615 | 2010-07-10 |
| Find all providers in zip 33615 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
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| 1992302574 | Avita Medical Clinic, LLC | General Practice | 14831 N Florida Ave, Tampa, FL 33613-1825 | 2020-10-06 |
| 1619586757 | American Care of Tampa, Inc. | General Practice | 8340 Stone Run Ct, Tampa, FL 33615-1879 | 2020-07-24 |
| 1003453499 | Healmi Technologies, LLC | General Practice | 3109 W Dr Martin Luther King Jr Blvd Ste 111, Tampa, FL 33607-6237 | 2019-12-04 |
| 1023507407 | Mildred Catherine Conneely | General Practice | 1701 W Jetton Ave, Tampa, FL 33606-3026 | 2018-05-01 |
| 1144725557 | John Henry Hoenemeyer II | General Practice | 325 W Frierson Ave, Tampa, FL 33603-1932 | 2018-03-27 |
| 1568980464 | Drsoncalls | General Practice | 449 S 12th St., Unit 2801, Tampa, FL 33602 | 2017-08-31 |
| 1033635149 | Peak Payer Solutions, Inc. | General Practice | 12332 Race Track Road, Tampa, FL 33626 | 2017-08-21 |
| 1114457272 | Nodal Medical Center LLC | General Practice | 2123 W Dr Martin Luther King Jr Blvd Ste 101, Tampa, FL 33607-6545 | 2017-06-12 |
| 1831624014 | Blake Jeffrey Fernandez | General Practice | 6101 Webb Rd Ste 101, Tampa, FL 33615-2859 | 2017-04-26 |
| Find all providers in TAMPA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.