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Organization
PHYSICIAN MANAGEMENT SERVICES OF FLORIDA LLC
Active
Organization
PHYSICIAN MANAGEMENT SERVICES OF FLORIDA LLC
Active
Parent organization
VAXCARE CORPORATION
Other names
VaxCare Florida LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
VAXCARE CORPORATION
Authorized official
CASEY DELOACH (PRESIDENT)
(888) 829-8550
Entity
Organization
Contact information
Practice address
400 GATLIN AVE, ORLANDO, FL 32806-6940
(888) 829-8550
(888) 843-7191
Mailing address
400 GATLIN AVE, ORLANDO, FL 32806-6940
(888) 829-8550
(888) 843-7191
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PHC059
MEDICARE PTAN
—
Enumeration date
10/18/2010
Last updated
09/20/2013
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