1699769042 NPI number — FLORIDA HEART & VASCULAR MULTI SPECIALTY GROUP PA

Table of content: (NPI 1699769042)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699769042 NPI number — FLORIDA HEART & VASCULAR MULTI SPECIALTY GROUP PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORIDA HEART & VASCULAR MULTI SPECIALTY GROUP 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:
FLORIDA HEART & VASCULAR CENTER
Provider Other Organization Name Type Code:
5
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:
1699769042
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
511 MEDICAL PLAZA DR
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
LEESBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34748-7326
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-728-6808
Provider Business Mailing Address Fax Number:
352-728-1743

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
511 MEDICAL PLAZA DR
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
LEESBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34748-7326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-728-6808
Provider Business Practice Location Address Fax Number:
352-728-1743
Provider Enumeration Date:
08/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FAUNDA
Authorized Official First Name:
JACKIE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN CREDENTIALING
Authorized Official Telephone Number:
352-728-6808

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QG0300X ; 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: "Y" .
  • Taxonomy code: 207RE0101X ; 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: "N" .
  • Taxonomy code: 207RN0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207UN0901X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 21798 . This is a "BCBS FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 255260400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 773114 . This is a "MAILHANDLERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 695956 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: CN9333 . This is a "GBA RR PALMETTO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7914953 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".




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