1861618753 NPI number — CENTRAL FLORIDA HEART ASSOCIATES PA

Table of content: (NPI 1861618753)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861618753 NPI number — CENTRAL FLORIDA HEART ASSOCIATES PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL FLORIDA HEART ASSOCIATES 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:
1861618753
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
932 SAXON BLVD
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
ORANGE CITY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32763-8313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-774-2100
Provider Business Mailing Address Fax Number:
386-774-0326

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
932 SAXON BLVD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
ORANGE CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32763-8313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-774-2100
Provider Business Practice Location Address Fax Number:
386-774-0326
Provider Enumeration Date:
04/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HIPPALGAONKAR
Authorized Official First Name:
RAJENDRA
Authorized Official Middle Name:
GOVIND
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
386-774-2100

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  ME046947 , 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: 011607900 . 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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