| Vivant Medical Group LLC | |
|
6214 Memorial Hwy Ste B Tampa FL 33615-4507 | |
| (800) 574-9491 | |
| (800) 547-2802 |
| Full Name | Vivant Medical Group LLC |
|---|---|
| Speciality | General Practice |
| Location | 6214 Memorial Hwy Ste B, Tampa, Florida |
| Authorized Official Name and Position | Daphnee Moise-johnson (PRESIDENT) |
| Authorized Official Contact | 8005749491 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Vivant Medical Group LLC 6214 Memorial Hwy Ste B Tampa FL 33615-4507 Ph: (800) 574-9491 | Vivant Medical Group LLC 6214 Memorial Hwy Ste B Tampa FL 33615-4507 Ph: (800) 574-9491 |
| NPI Number | 1124652425 |
|---|---|
| Provider Enumeration Date | 02/25/2020 |
| Last Update Date | 07/06/2021 |
| Certification Date | 07/06/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124652425 | NPI | - | NPPES |
| 273932100 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | () | Primary |
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