Medvital Physician Care Group

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

ACN684 Issued in FL

Legal business name

MEDVITAL PHYSICIAN CARE GROUP

Practice address

102 Park Place Blvd
Kissimmee, FL 34741-2358

Phone

(407) 847-5805

NPI assigned

Aug 20, 2016

Last updated

Aug 20, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Saadia Fersobe, MD

Title

Medical Director

Phone

(407) 847-5805

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1471651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471651200000",
    "number": "1538614433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 PARK PLACE BLVD",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347412358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 PARK PLACE BLVD",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347412358",
            "telephone_number": "407-847-5805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDVITAL PHYSICIAN CARE GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-20",
        "last_updated": "2016-08-20",
        "status": "A",
        "authorized_official_last_name": "FERSOBE",
        "authorized_official_first_name": "SAADIA",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "407-847-5805",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "FL",
            "license": "ACN684",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Santa Medina
• Tony Alejandro Medina Sr.
• Medisound Inc
• Medoz Pharmacy of Osceola Inc
• Medteam Group, LLC (Physical Therapy Now Kissimmee)
• Medvital Walk in Lab and Clinic, LLC
• Sanjay Mehra, M.D.
• Varun Mehta
• Sara Ann Meinz, DO
• Ivette Mejia-Diaz, LMT

• Clinic/Center in Kissimmee, FL
• Providers in Kissimmee, FL by specialty
• Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2016; 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.