Provider Demographics
NPI:1275590192
Name:HEART STUDY CENTER INC
Entity Type:Organization
Organization Name:HEART STUDY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BLANCA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-834-1151
Mailing Address - Street 1:755 W STATE ROAD 434
Mailing Address - Street 2:SUITE A
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-5156
Mailing Address - Country:US
Mailing Address - Phone:407-834-1151
Mailing Address - Fax:407-834-2232
Practice Address - Street 1:755 W STATE ROAD 434
Practice Address - Street 2:SUITE A
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5156
Practice Address - Country:US
Practice Address - Phone:407-834-1151
Practice Address - Fax:407-834-2232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP97000031620246XS1301X, 2471S1302X, 261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Multi-Specialty
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL27291OtherWELLCARE
FL7975214OtherAETNA
FL208707OtherAMERIGROUP
FLV2099OtherBCBS
FL470000208OtherMEDICARE RAILROAD
FL9481963OtherCIGNA
FL40424912OtherUNITED HEALTHCARE
FL9721261OtherGHI
FL9721261OtherGHI