Provider Demographics
NPI:1538111513
Name:CARDIOLOGY PHYSICIANS PA
Entity Type:Organization
Organization Name:CARDIOLOGY PHYSICIANS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:CARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-677-5651
Mailing Address - Street 1:305 MEMORIAL MEDICAL PARKWAY
Mailing Address - Street 2:STE 301
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117
Mailing Address - Country:US
Mailing Address - Phone:386-677-5351
Mailing Address - Fax:
Practice Address - Street 1:305 MEMORIAL MEDICAL PARKWAY
Practice Address - Street 2:STE 301
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117
Practice Address - Country:US
Practice Address - Phone:386-677-5351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL060113602Medicaid
FLD57641Medicare UPIN
FLD61925Medicare UPIN
FLD58898Medicare UPIN
FL060113602Medicaid