Provider Demographics
NPI:1326553793
Name:PEACE RIVER CARDIOVASCULAR CENTER
Entity Type:Organization
Organization Name:PEACE RIVER CARDIOVASCULAR CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:GOFF
Authorized Official - Last Name:BANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-629-5356
Mailing Address - Street 1:4161 TAMIAMI TRL STE 701
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-9283
Mailing Address - Country:US
Mailing Address - Phone:941-629-5356
Mailing Address - Fax:941-629-4987
Practice Address - Street 1:4161 TAMIAMI TRL STE 701
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952
Practice Address - Country:US
Practice Address - Phone:941-629-5356
Practice Address - Fax:941-629-4987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-07
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty