1104814714 NPI number — INTERVENTIONAL CARDIAC CONSULTANTS PLC

Table of content: (NPI 1104814714)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104814714 NPI number — INTERVENTIONAL CARDIAC CONSULTANTS PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERVENTIONAL CARDIAC CONSULTANTS PLC
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:
6
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:
1104814714
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2035 LITTLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRINITY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34655-4421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-842-9486
Provider Business Mailing Address Fax Number:
727-849-2623

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2035 LITTLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRINITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34655-4421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-842-9486
Provider Business Practice Location Address Fax Number:
727-849-2623
Provider Enumeration Date:
10/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KUNHARDT
Authorized Official First Name:
RENE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
AUTHORIZED OFFICIAL / MD
Authorized Official Telephone Number:
727-842-9486

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: 40897 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 260351900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com