Organization
LIFELINE VASCULAR CENTER NICEVILLE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON LOHMEYER (CFO)
(847) 949-3855
Entity
Organization
Contact information
Practice address
4585 E HIGHWAY 20 STE 125, NICEVILLE, FL 32578-7709
(850) 678-0184
(850) 678-0155
Mailing address
PO BOX 782282, PHILADELPHIA, PA 19178-2282
(847) 388-2001
(847) 388-2020
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
—
—
2085R0204X
Vascular & Interventional Radiology Physician
Primary
—
—
2086S0129X
Vascular Surgery Physician
—
—
Other
Enumeration date
06/03/2013
Last updated
06/30/2021
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