Provider Demographics
NPI: | 1023039294 |
---|---|
Name: | BRADENTON CARDIOLOGY CENTER MANAGEMENT SERVICES, INC |
Entity Type: | Organization |
Organization Name: | BRADENTON CARDIOLOGY CENTER MANAGEMENT SERVICES, INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ALBERTO |
Authorized Official - Middle Name: | E |
Authorized Official - Last Name: | MONTALVO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 941-742-6384 |
Mailing Address - Street 1: | 316 MANATEE AVE W |
Mailing Address - Street 2: | |
Mailing Address - City: | BRADENTON |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 34205-8805 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 316 MANATEE AVE W |
Practice Address - Street 2: | |
Practice Address - City: | BRADENTON |
Practice Address - State: | FL |
Practice Address - Zip Code: | 34205-8805 |
Practice Address - Country: | US |
Practice Address - Phone: | 941-742-6384 |
Practice Address - Fax: | 941-745-4244 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-07-22 |
Last Update Date: | 2007-07-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Single Specialty |