1316977390 NPI number — CARDIOLOGY ASSOCIATES OF CHARLOTTE COUNTY, PA

Table of content: (NPI 1316977390)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316977390 NPI number — CARDIOLOGY ASSOCIATES OF CHARLOTTE COUNTY, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDIOLOGY ASSOCIATES OF CHARLOTTE COUNTY, 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:
CARDIOLOGY ASSOCIATES
Provider Other Organization Name Type Code:
3
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:
1316977390
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 495156
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT CHARLOTTE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33949-5156
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-629-4500
Provider Business Mailing Address Fax Number:
941-629-4171

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2300 LOVELAND BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT CHARLOTTE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33980-5716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-629-4500
Provider Business Practice Location Address Fax Number:
941-629-4171
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROSENFIELD
Authorized Official First Name:
LOUIS
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
941-629-4500

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 046061300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 47573 . This is a "HEALTH AMERICA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 97045 . This is a "WELLCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0089566 . This is a "GHI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 97122 . This is a "BLUE SHIELD OF FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 060008508 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 4527228 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 269406 . This is a "FEDERAL BLACK LUNG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110819400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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