LIFELINE VASCULAR CENTER NICEVILLE LLC NPI 1962849794

NPI Information

LIFELINE VASCULAR CENTER NICEVILLE LLC is a vascular and interventional radiology radiology in Niceville, FL. The provider is a radiologist who diagnoses and treats diseases by various radiologic imaging modalities. These include fluoroscopy, digital radiography, computed tomography, sonography and magnetic resonance imaging. LIFELINE VASCULAR CENTER NICEVILLE LLC NPI is 1962849794. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

4585 E HIGHWAY 20 STE 125
NICEVILLE, FL
ZIP 32578-709
Phone: (850) 678-0184
Fax: (850) 678-0155

The provider's authorized official is Jason Lohmeyer .
The authorized official title is Cfo and has the following contact phone number (847) 949-3855.

The CLIA number assigned to this NPI record is 10D2066133 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/3/2013 and was last updated on 6/30/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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