Evolves Vascular Lab, LLC

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

58979 Issued in FL

Legal business name

EVOLVES VASCULAR LAB, LLC

Practice address

588 Sterthaus Dr
Ormond Beach, FL 32174-5128

Phone

(386) 672-9501

Fax

(386) 673-0308

NPI assigned

Nov 8, 2013

Last updated

Nov 13, 2013By 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

Vicky Browning

Title

Office Manager

Phone

(386) 672-9501

Specialties & licenses 2

Addresses

Other identifiers 4

Other names 1

• Atlantic Cardiovacular & Thoracic Surgeons, LLC Other name

Member of 1

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

• Atlantic Cardiovascular & Thoracic Surgeons, LLC

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Ormond Beach, FL
  • NPI 1962831883

  Member Of

  NPD member

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• John Blake Holt, M.D.

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Ormond Beach, FL
  • NPI 1932195385
  NPD (past)

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

{
    "created_epoch": "1383868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384300800000",
    "number": "1548699606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "588 STERTHAUS DR",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321745128",
            "telephone_number": "386-672-9501",
            "fax_number": "386-673-0308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "588 STERTHAUS DR",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321745128",
            "telephone_number": "386-672-9501",
            "fax_number": "386-673-0308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVOLVES VASCULAR LAB, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-08",
        "last_updated": "2013-11-13",
        "status": "A",
        "authorized_official_last_name": "BROWNING",
        "authorized_official_first_name": "VICKY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "386-672-9501"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "FL",
            "license": "58979",
            "primary": true
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "FL",
            "license": "58979",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1932195385",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1245226695",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "041690800",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "371580900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Atlantic Cardiovacular & Thoracic Surgeons, LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Vascular Surgery Physician in Ormond Beach, FL
• Providers in Ormond Beach, FL by specialty
• Vascular Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2013; 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.