Provider Demographics
NPI:1760440440
Name:FLORIDA HEART CENTER, PA
Entity Type:Organization
Organization Name:FLORIDA HEART CENTER, PA
Other - Org Name:FLORIDA HEART CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PRASAD
Authorized Official - Middle Name:
Authorized Official - Last Name:CHALASANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-465-4499
Mailing Address - Street 1:1900 NEBRASKA AVE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4837
Mailing Address - Country:US
Mailing Address - Phone:772-465-4499
Mailing Address - Fax:772-465-5941
Practice Address - Street 1:1900 NEBRASKA AVE
Practice Address - Street 2:SUITE 9
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4837
Practice Address - Country:US
Practice Address - Phone:772-465-4757
Practice Address - Fax:772-466-0832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RC0000X
FLME0072976207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253894600Medicaid
FLF70661Medicare UPIN
FL253894600Medicaid