Provider Demographics
NPI:1154304657
Name:CAPE HEART GROUP INC
Entity Type:Organization
Organization Name:CAPE HEART GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:TEOFILO
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-454-4461
Mailing Address - Street 1:255 BORMAN DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-3486
Mailing Address - Country:US
Mailing Address - Phone:321-454-4461
Mailing Address - Fax:321-454-4977
Practice Address - Street 1:255 BORMAN DR
Practice Address - Street 2:SUITE 202
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-3486
Practice Address - Country:US
Practice Address - Phone:321-454-4461
Practice Address - Fax:321-454-4977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-29
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBC/BS OF FLORIDAOther38549
FL38549Medicare ID - Type UnspecifiedMEDICARE GROUP #