Provider Demographics
NPI:1790882900
Name:LONGBOAT CARDIOLOGY PA
Entity Type:Organization
Organization Name:LONGBOAT CARDIOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:HEALY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-383-7300
Mailing Address - Street 1:5650 GULF OF MEXICO DR
Mailing Address - Street 2:
Mailing Address - City:LONGBOAT KEY
Mailing Address - State:FL
Mailing Address - Zip Code:34228-1906
Mailing Address - Country:US
Mailing Address - Phone:941-383-7300
Mailing Address - Fax:941-383-7335
Practice Address - Street 1:5650 GULF OF MEXICO DR
Practice Address - Street 2:
Practice Address - City:LONGBOAT KEY
Practice Address - State:FL
Practice Address - Zip Code:34228-1906
Practice Address - Country:US
Practice Address - Phone:941-383-7300
Practice Address - Fax:941-383-7335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51094174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL064203700Medicaid
FL10903AMedicare ID - Type Unspecified
FL064203700Medicaid