Organization
EVOLVES VASCULAR LAB, LLC
Active
Other names
Atlantic Cardiovacular & Thoracic Surgeons, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
VICKY BROWNING (OFFICE MANAGER)
(386) 672-9501
Entity
Organization
Contact information
Practice address
588 STERTHAUS DR, ORMOND BEACH, FL 32174-5128
(386) 672-9501
(386) 673-0308
Mailing address
588 STERTHAUS DR, ORMOND BEACH, FL 32174-5128
(386) 672-9501
(386) 673-0308
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
58979
FL
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
58979
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
041690800
—
FL
01
—
1245226695
NPI
—
01
—
1932195385
NPI
FL
05
—
371580900
—
FL
Enumeration date
11/08/2013
Last updated
11/13/2013
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