Provider Demographics
NPI:1083759401
Name:CLINICAL & PREVENTIVE CARDIOLOGY INC
Entity Type:Organization
Organization Name:CLINICAL & PREVENTIVE CARDIOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HORACE
Authorized Official - Middle Name:PUTNAM
Authorized Official - Last Name:DANSBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-772-7350
Mailing Address - Street 1:1435 SE 8TH TER
Mailing Address - Street 2:SUITE C
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-3289
Mailing Address - Country:US
Mailing Address - Phone:239-772-7350
Mailing Address - Fax:239-772-8570
Practice Address - Street 1:1435 SE 8TH TER
Practice Address - Street 2:SUITE C
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3289
Practice Address - Country:US
Practice Address - Phone:239-772-7350
Practice Address - Fax:239-772-8570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXME20581174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD54416Medicare UPIN
FLK7246Medicare ID - Type Unspecified