1801306428 NPI number — HEART OF CENTRAL FLORIDA, P.A.

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 1801306428 NPI number — HEART OF CENTRAL FLORIDA, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEART OF CENTRAL FLORIDA, P.A.
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:
1801306428
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
845 OAKLEY SEAVER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLERMONT
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34711-1968
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-432-9585
Provider Business Mailing Address Fax Number:
352-708-4046

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
845 OAKLEY SEAVER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLERMONT
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34711-1968
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-432-9585
Provider Business Practice Location Address Fax Number:
352-708-4046
Provider Enumeration Date:
10/10/2017

Additional Information

Authorized Official

Authorized Official Last Name:
KANTOUNIS
Authorized Official First Name:
LOUIS
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
352-432-9585

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: 105945300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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