Provider Demographics
NPI:1568541837
Name:HEART CENTER OF CHARLOTTE PA
Entity Type:Organization
Organization Name:HEART CENTER OF CHARLOTTE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:STONIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-625-6223
Mailing Address - Street 1:2484 CARING WAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952
Mailing Address - Country:US
Mailing Address - Phone:941-625-6223
Mailing Address - Fax:941-627-2680
Practice Address - Street 1:2484 CARING WAY
Practice Address - Street 2:SUITE B
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952
Practice Address - Country:US
Practice Address - Phone:941-625-6223
Practice Address - Fax:941-627-2680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53389207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D97411Medicare UPIN