Provider Demographics
NPI:1760836316
Name:FLORIDA PREMIER CARDIOLOGY, LLC
Entity Type:Organization
Organization Name:FLORIDA PREMIER CARDIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRILLO-JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-807-0500
Mailing Address - Street 1:11195 S JOG RD STE 6
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-1830
Mailing Address - Country:US
Mailing Address - Phone:561-807-0500
Mailing Address - Fax:866-214-6612
Practice Address - Street 1:11195 S JOG RD STE 6
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-1830
Practice Address - Country:US
Practice Address - Phone:561-807-0500
Practice Address - Fax:866-214-6612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82672207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLEU741XMedicare PIN
FLAV116AMedicare PIN