Provider Demographics
NPI:1790871028
Name:HEART OF FLORIDA OB/GYN ASSOCIATES PA
Entity Type:Organization
Organization Name:HEART OF FLORIDA OB/GYN ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFC MGR
Authorized Official - Prefix:
Authorized Official - First Name:MARCI
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-421-7600
Mailing Address - Street 1:PO BOX 667
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33836-0667
Mailing Address - Country:US
Mailing Address - Phone:863-421-7600
Mailing Address - Fax:863-421-7551
Practice Address - Street 1:2221 NORTH BLVD W
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-8990
Practice Address - Country:US
Practice Address - Phone:863-421-7600
Practice Address - Fax:863-421-7551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258034900Medicaid
FLK1241Medicare ID - Type Unspecified