Provider Demographics
NPI:1164948360
Name:HEART RHYTHM SPECIALISTS AT DAYTONA LLC
Entity Type:Organization
Organization Name:HEART RHYTHM SPECIALISTS AT DAYTONA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:S
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-316-0955
Mailing Address - Street 1:305 MEMORIAL MEDICAL PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5170
Mailing Address - Country:US
Mailing Address - Phone:386-672-1023
Mailing Address - Fax:386-263-2996
Practice Address - Street 1:305 MEMORIAL MEDICAL PKWY STE 300
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5170
Practice Address - Country:US
Practice Address - Phone:386-672-1023
Practice Address - Fax:386-263-2996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-18
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00115440Medicaid