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

Table of content: (NPI 1518175470)

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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