1447277322 NPI number — FLORIDA CARDIOVASCULAR INSTITUTE PA

Table of content: (NPI 1447277322)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447277322 NPI number — FLORIDA CARDIOVASCULAR INSTITUTE PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORIDA CARDIOVASCULAR INSTITUTE 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:
1447277322
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
509 S ARMENIA AVE
Provider Second Line Business Mailing Address:
STE. 200
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33609-3395
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-353-1515
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
509 S ARMENIA AVE
Provider Second Line Business Practice Location Address:
STE. 200
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33609-3395
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-353-1515
Provider Business Practice Location Address Fax Number:
813-353-0485
Provider Enumeration Date:
07/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SULLEBARGER
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
THOMPSON
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
813-353-1515

Provider Taxonomy Codes

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

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

  • Identifier: 21968 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 255769000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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