Provider Demographics
NPI:1992707855
Name:VESC LLC
Entity type:Organization
Organization Name:VESC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR, MD
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:TOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-271-7105
Mailing Address - Street 1:550 MEMORIAL CIR STE G
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5055
Mailing Address - Country:US
Mailing Address - Phone:386-231-7151
Mailing Address - Fax:386-231-6545
Practice Address - Street 1:550 MEMORIAL CIR STE G
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5055
Practice Address - Country:US
Practice Address - Phone:862-717-1053
Practice Address - Fax:862-316-5463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL786261QA1903X
261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL63FOtherBLUE CROSS BLUE SHIELD FL
FL079123700Medicaid
FL63FOtherBLUE CROSS BLUE SHIELD FL