1518175470 NPI number — INTERVENTIONAL CARDIOLOGY AND VASCULAR CONSULTANTS, P.L.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518175470 NPI number — INTERVENTIONAL CARDIOLOGY AND VASCULAR CONSULTANTS, P.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERVENTIONAL CARDIOLOGY AND VASCULAR CONSULTANTS, P.L.C.
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:
1518175470
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1206 N MILLS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32803-2560
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-898-8449
Provider Business Mailing Address Fax Number:
407-898-8756

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1206 N MILLS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32803-2560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-898-8449
Provider Business Practice Location Address Fax Number:
407-898-8756
Provider Enumeration Date:
05/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PAL
Authorized Official First Name:
ASHISH
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/MEDICAL DIRECTOR
Authorized Official Telephone Number:
407-898-8449

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; 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: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10162813 . This is a "WAUSAU" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 242799 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 10481803 . This is a "TRICARE -DAVENPORT LOCATION" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 107503044 . This is a "CIGNA PPO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1095816 . This is a "AMERIGROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1780 . This is a "UNIVERSAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: V0488201 . This is a "CITRUS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 10481801 . This is a "TRICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 32314 . This is a "SSS OF PUERTO RICO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 19851 . This is a "WELLCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2004394 . This is a "AETNA HMO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 60069629 . This is a "RAILROAD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 631717 . This is a "HUMANA PPO- INDIVIDUAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7503044009 . This is a "CIGNA HMO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: WMTRX . This is a "BC/BS FACILITY" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1015450 . This is a "CAREPLUS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1095816 . This is a "AMERICAN AGE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1513060 . This is a "WELLCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 5083655 . This is a "AETNA PPO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 225252 . This is a "HUMANA GROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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