Provider Demographics
NPI:1245976752
Name:MEDICAL CENTRE OF PALMETTO BAY, LLC
Entity type:Organization
Organization Name:MEDICAL CENTRE OF PALMETTO BAY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VEACESLAV
Authorized Official - Middle Name:
Authorized Official - Last Name:VLASDOM,
Authorized Official - Suffix:
Authorized Official - Credentials:DOM,PHD
Authorized Official - Phone:786-573-4777
Mailing Address - Street 1:14471 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33176-7924
Mailing Address - Country:US
Mailing Address - Phone:786-573-4777
Mailing Address - Fax:786-339-9544
Practice Address - Street 1:14471 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33176-7924
Practice Address - Country:US
Practice Address - Phone:786-573-4777
Practice Address - Fax:786-339-9544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-08
Last Update Date:2022-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty