Provider Demographics
NPI:1376532036
Name:NORTHWEST FLORIDA HEART GROUP PA
Entity Type:Organization
Organization Name:NORTHWEST FLORIDA HEART GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIENT/CARDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-969-7979
Mailing Address - Street 1:PO BOX 11339
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32524-1339
Mailing Address - Country:US
Mailing Address - Phone:850-969-7979
Mailing Address - Fax:850-476-9352
Practice Address - Street 1:8333 N DAVIS HWY
Practice Address - Street 2:4TH FLOOR
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6050
Practice Address - Country:US
Practice Address - Phone:850-969-7979
Practice Address - Fax:850-476-9352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL38384OtherBCBS
FL38384Medicare ID - Type Unspecified