Provider Demographics
NPI:1558441550
Name:CHARLOTTE HEART AND VASCULAR INSTITUTE PA
Entity Type:Organization
Organization Name:CHARLOTTE HEART AND VASCULAR INSTITUTE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING/CODING MANG.
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHULDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-764-5858
Mailing Address - Street 1:PO BOX 495120
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33949-5120
Mailing Address - Country:US
Mailing Address - Phone:941-764-5858
Mailing Address - Fax:941-613-1300
Practice Address - Street 1:3340 TAMIAMI TRAIL
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8088
Practice Address - Country:US
Practice Address - Phone:941-764-5858
Practice Address - Fax:941-764-1627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0972Medicare UPIN