1215248281 NPI number — FLORIDA CARDIOVASCULAR SPECIALISTS, PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215248281 NPI number — FLORIDA CARDIOVASCULAR SPECIALISTS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORIDA CARDIOVASCULAR SPECIALISTS, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215248281
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1020 E NORTH BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEESBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34748-5348
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-326-1731
Provider Business Mailing Address Fax Number:
352-728-2498

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 N US HIGHWAY 441
Provider Second Line Business Practice Location Address:
BLDG 1000, STE 1002
Provider Business Practice Location Address City Name:
THE VILLAGES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32159-8999
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-259-4460
Provider Business Practice Location Address Fax Number:
352-391-1528
Provider Enumeration Date:
06/24/2010

Additional Information

Authorized Official

Authorized Official Last Name:
GARCIA
Authorized Official First Name:
HECTOR
Authorized Official Middle Name:
LUIS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
352-259-4460

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  ME75954 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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