Provider Demographics
NPI:1477662310
Name:BOCA HEART GROUP P A
Entity Type:Organization
Organization Name:BOCA HEART GROUP P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:A
Authorized Official - Last Name:COWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-274-8933
Mailing Address - Street 1:601 N CONGRESS AVE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-4621
Mailing Address - Country:US
Mailing Address - Phone:561-274-8933
Mailing Address - Fax:561-274-8869
Practice Address - Street 1:601 N CONGRESS AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-4621
Practice Address - Country:US
Practice Address - Phone:561-274-8933
Practice Address - Fax:561-274-8869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME52904174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254010000Medicaid
FLK1774Medicare PIN