Biovantra LLC

Primary specialty

Anatomic Pathology PhysicianTaxonomy code 207ZP0101X

License

800025941 Issued in FL

Legal business name

BIOVANTRA LLC

Practice address

9401 SW Highway 200 Ste 502
Ocala, FL 34481-9650

Phone

(352) 861-2296

Fax

(352) 671-2737

NPI assigned

May 5, 2008

Last updated

May 8, 2018By 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

Dr. Donald Russell Locke, M.D.NPI 1497703912

Title

Managing Member

Phone

(352) 861-2296

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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.

• Donald Russell Locke, MD

  • Urology Physician
  • Ocala, FL
  • NPI 1497703912
  NPD Authorized official

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

{
    "created_epoch": "1209945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525737600000",
    "number": "1891961462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 772287",
            "city": "OCALA",
            "state": "FL",
            "postal_code": "344772287",
            "telephone_number": "352-861-2296",
            "fax_number": "352-671-2737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9401 SW HIGHWAY 200 STE 502",
            "city": "OCALA",
            "state": "FL",
            "postal_code": "344819650",
            "telephone_number": "352-861-2296",
            "fax_number": "352-671-2737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BIOVANTRA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-05",
        "last_updated": "2018-05-08",
        "status": "A",
        "authorized_official_last_name": "LOCKE",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "RUSSELL",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "352-861-2296",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ZP0101X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology",
            "state": "FL",
            "license": "800025941",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Anatomic Pathology Physician in Ocala, FL
• Providers in Ocala, FL by specialty
• Anatomic Pathology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.