NPIMap

Organization Active NPI

Lifeline Vascular Center of South Orlando, LLC

  • Nephrology Physician
  • Orlando, FL
National Provider Identifier
1053668228
Registry record updated Aug 7, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
LIFELINE VASCULAR CENTER OF SOUTH ORLANDO, LLC
Practice address
1511 Sligh Blvd
Suite a
Orlando, FL 32806-3959
Phone
(847) 949-3845
Fax
(866) 408-5072
NPI assigned
Aug 7, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
James Hilger
Title
Chief Accounting Officer
Phone
(253) 280-9501

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RN0300X Primary
Vascular & Interventional Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0204X
Vascular Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0129X

Addresses

Primary practice location

1511 Sligh Blvd
Suite a
Orlando, FL 32806-3959

Mailing address

3 W Hawthorn Pkwy
Suite 410
Vernon Hills, IL 60061-1446
Phone (847) 388-2001

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1511 Sligh Blvd
Unit A
Orlando, FL 32806
Phone (407) 317-9000

3 W Hawthorn Pkwy
Ste 410
Vernon Hills, IL 60061
Phone (847) 388-2001

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1344297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344297600000",
    "number": "1053668228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 W HAWTHORN PKWY",
            "address_2": "SUITE 410",
            "city": "VERNON HILLS",
            "state": "IL",
            "postal_code": "600611446",
            "telephone_number": "847-388-2001",
            "fax_number": "847-388-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1511 SLIGH BLVD",
            "address_2": "SUITE A",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328063959",
            "telephone_number": "847-949-3845",
            "fax_number": "866-408-5072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFELINE VASCULAR CENTER OF SOUTH ORLANDO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-07",
        "last_updated": "2012-08-07",
        "status": "A",
        "authorized_official_last_name": "HILGER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "CHIEF ACCOUNTING OFFICER",
        "authorized_official_telephone_number": "253-280-9501"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.