Provider Demographics
NPI:1467959668
Name:CARDIOLOGY PRACTICE PA
Entity Type:Organization
Organization Name:CARDIOLOGY PRACTICE PA
Other - Org Name:CARDIOLOGY PRACTICES PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BILLING MANANGER
Authorized Official - Prefix:
Authorized Official - First Name:MARISOL
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-240-8373
Mailing Address - Street 1:5051 ASHINGTON LANDING DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3515
Mailing Address - Country:US
Mailing Address - Phone:813-781-5119
Mailing Address - Fax:
Practice Address - Street 1:5051 ASHINGTON LANDING DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3515
Practice Address - Country:US
Practice Address - Phone:813-781-5119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-12
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherCARDILOGY