Provider Demographics
NPI:1467778381
Name:CLEARWATER CARDIOVASCULAR & INTERVENTIONAL CONSULTANTS
Entity Type:Organization
Organization Name:CLEARWATER CARDIOVASCULAR & INTERVENTIONAL CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERIC
Authorized Official - Middle Name:R
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:JR
Authorized Official - Credentials:CPA
Authorized Official - Phone:727-445-1992
Mailing Address - Street 1:455 PINELLAS ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3354
Mailing Address - Country:US
Mailing Address - Phone:727-445-1992
Mailing Address - Fax:727-445-1993
Practice Address - Street 1:1840 MEASE DR
Practice Address - Street 2:SUITE 202
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-6602
Practice Address - Country:US
Practice Address - Phone:727-725-6246
Practice Address - Fax:727-726-5865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-16
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL119872601Medicaid
77113Medicare PIN