Provider Demographics
NPI:1508867870
Name:CARDIOVASCULAR ASSOCIATES INC
Entity Type:Organization
Organization Name:CARDIOVASCULAR ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNSON
Authorized Official - Middle Name:P
Authorized Official - Last Name:MASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-846-0626
Mailing Address - Street 1:601 OAK COMMONS BLVD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4213
Mailing Address - Country:US
Mailing Address - Phone:407-846-0626
Mailing Address - Fax:407-846-2371
Practice Address - Street 1:601 OAK COMMONS BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4213
Practice Address - Country:US
Practice Address - Phone:407-846-0626
Practice Address - Fax:407-846-2371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL91700049142207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372298800Medicaid
FL372298800Medicaid