Provider Demographics
NPI:1336313451
Name:SOUTHERN HEART GROUP PA
Entity Type:Organization
Organization Name:SOUTHERN HEART GROUP PA
Other - Org Name:ST LUKES CARDIOLOGY ASSOCIATES A
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:PILCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-388-1820
Mailing Address - Street 1:6867 SOUTHPOINT DR N
Mailing Address - Street 2:SUITE 111
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-8043
Mailing Address - Country:US
Mailing Address - Phone:904-296-0278
Mailing Address - Fax:904-296-0279
Practice Address - Street 1:6867 SOUTHPOINT DR N
Practice Address - Street 2:SUITE 111
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8043
Practice Address - Country:US
Practice Address - Phone:904-296-0278
Practice Address - Fax:904-296-0279
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN HEART GROUP PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL99568Medicare PIN