Provider Demographics
NPI:1679397749
Name:SAINT VIL MEDICAL CARE SERVICES LLC
Entity type:Organization
Organization Name:SAINT VIL MEDICAL CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANTZ
Authorized Official - Middle Name:
Authorized Official - Last Name:SAINT-VIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-776-2664
Mailing Address - Street 1:3520 CROAKER DR
Mailing Address - Street 2:
Mailing Address - City:HERNANDO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34607-3640
Mailing Address - Country:US
Mailing Address - Phone:813-264-5600
Mailing Address - Fax:
Practice Address - Street 1:15415 N FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-1243
Practice Address - Country:US
Practice Address - Phone:813-264-5600
Practice Address - Fax:813-762-1658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-14
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL118387400Medicaid