Provider Demographics
NPI:1902125826
Name:VMG PULMONARY & SLEEP DISORDER CENTER PA
Entity Type:Organization
Organization Name:VMG PULMONARY & SLEEP DISORDER CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIVIC
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-350-1600
Mailing Address - Street 1:3367 WEDGEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-7181
Mailing Address - Country:US
Mailing Address - Phone:352-350-1600
Mailing Address - Fax:352-750-8032
Practice Address - Street 1:3367 WEDGEWOOD LN
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-7181
Practice Address - Country:US
Practice Address - Phone:352-350-1600
Practice Address - Fax:352-750-8032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic