Provider Demographics
NPI:1316058217
Name:VAXCARE CORPORATION
Entity type:Organization
Organization Name:VAXCARE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:KENEFICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-829-8550
Mailing Address - Street 1:3113 LAWTON RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-3531
Mailing Address - Country:US
Mailing Address - Phone:888-829-8550
Mailing Address - Fax:855-418-9149
Practice Address - Street 1:3113 LAWTON RD
Practice Address - Street 2:SUITE 250
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-3531
Practice Address - Country:US
Practice Address - Phone:888-829-8550
Practice Address - Fax:855-418-9149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00430804OtherRAILROAD MEDICARE
PHC059Medicare PIN