Provider Demographics
NPI:1043427107
Name:FLORIDA HEART CENTER PA
Entity Type:Organization
Organization Name:FLORIDA HEART CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOSSEIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMEZANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-269-1664
Mailing Address - Street 1:PO BOX 365
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32067-0365
Mailing Address - Country:US
Mailing Address - Phone:904-269-1664
Mailing Address - Fax:904-264-4085
Practice Address - Street 1:1518 KINGSLEY AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4511
Practice Address - Country:US
Practice Address - Phone:904-269-1664
Practice Address - Fax:904-264-4085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL040894800Medicaid
FL10988Medicare PIN