1639898380 NPI number — CARDIOVASCULAR INSTITUTE OF NW FLORIDA CENTER OF EXCELLENCE, LLC

Table of content: (NPI 1639898380)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639898380 NPI number — CARDIOVASCULAR INSTITUTE OF NW FLORIDA CENTER OF EXCELLENCE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDIOVASCULAR INSTITUTE OF NW FLORIDA CENTER OF EXCELLENCE, LLC
Provider Last Name:
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Provider Middle Name:
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Provider's Other Name Information

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NPI Number Information

NPI Number:
1639898380
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13830 SAWYER RANCH RD STE 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DRIPPING SPRINGS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78620-5514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
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Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
625 W BALDWIN RD STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PANAMA CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32405-3359
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-621-5621
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/25/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LEGER
Authorized Official First Name:
JARED
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
337-274-6549

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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