1346791498 NPI number — ANSAARIE CARDIAC & ENDOVASCULAR CENTER OF EXCELLENCE

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 1346791498 NPI number — ANSAARIE CARDIAC & ENDOVASCULAR CENTER OF EXCELLENCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANSAARIE CARDIAC & ENDOVASCULAR CENTER OF EXCELLENCE
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:
ANSAARIE CARDIAC & ENDOVASCULAR CENTER OF EXCELLENCE
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:
1346791498
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/25/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
209 PINEHURST POINTE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST AUGUSTINE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32092-3703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-232-9203
Provider Business Mailing Address Fax Number:
386-222-3064

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 HWY 17S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST PALATKA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32131-4087
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-232-9203
Provider Business Practice Location Address Fax Number:
386-222-3064
Provider Enumeration Date:
10/24/2016

Additional Information

Authorized Official

Authorized Official Last Name:
ANSAARIE
Authorized Official First Name:
IMRAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
386-232-9203

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  ME121178 , 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)

  • Identifier: 012828200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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