Provider Demographics
NPI:1740771799
Name:CARDIAC CATH LAB OF EAST FORT LAUDERDALE, LLC
Entity Type:Organization
Organization Name:CARDIAC CATH LAB OF EAST FORT LAUDERDALE, LLC
Other - Org Name:FT. LAUDERDALE HEART & RHYTHM CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BEMIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-644-8900
Mailing Address - Street 1:DEPT #3032, PO BOX 4417
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4477
Mailing Address - Country:US
Mailing Address - Phone:106-448-9006
Mailing Address - Fax:484-924-0053
Practice Address - Street 1:1925 NE 45TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308
Practice Address - Country:US
Practice Address - Phone:713-812-7586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-25
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty