1295726123 NPI number — GULF CARDIOLOGY ASSOCIATES

Table of content: (NPI 1295726123)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295726123 NPI number — GULF CARDIOLOGY ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GULF CARDIOLOGY ASSOCIATES
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:
1295726123
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 20205
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33622-0205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-823-2188
Provider Business Mailing Address Fax Number:
727-828-0723

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5326 GULF DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW PORT RICHEY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34652-3920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-848-3381
Provider Business Practice Location Address Fax Number:
727-848-8498
Provider Enumeration Date:
10/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
UBILLUS
Authorized Official First Name:
RICARDO
Authorized Official Middle Name:
ELMER
Authorized Official Title or Position:
OWNER/PARTNER
Authorized Official Telephone Number:
727-848-3381

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: CB0248 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 372551100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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