Provider Demographics
NPI:1023029154
Name:CARDIO CARE CENTER INC.
Entity Type:Organization
Organization Name:CARDIO CARE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:DREYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-326-3633
Mailing Address - Street 1:700 ZEAGLER DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177
Mailing Address - Country:US
Mailing Address - Phone:386-326-3633
Mailing Address - Fax:386-312-5080
Practice Address - Street 1:700 ZEAGLER DR
Practice Address - Street 2:SUITE 2
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177
Practice Address - Country:US
Practice Address - Phone:386-326-3633
Practice Address - Fax:386-312-5080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78625207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47147OtherBLUE CROSS/BLUE SHIELD FL
FL257396200Medicaid
FL47147Medicare PIN
FL47147OtherBLUE CROSS/BLUE SHIELD FL