Provider Demographics
NPI:1841592086
Name:FLORIDA HEART & VASCULAR MULTI SPECIALTY CLINIC
Entity Type:Organization
Organization Name:FLORIDA HEART & VASCULAR MULTI SPECIALTY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:K
Authorized Official - Last Name:LEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-728-6808
Mailing Address - Street 1:511 MEDICAL PLAZA DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-7326
Mailing Address - Country:US
Mailing Address - Phone:352-768-6808
Mailing Address - Fax:352-768-3637
Practice Address - Street 1:4120 CORLEY ISLAND RD
Practice Address - Street 2:SUITE 500
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-8292
Practice Address - Country:US
Practice Address - Phone:352-326-6011
Practice Address - Fax:352-326-6014
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA HEART & VASCULAR MULTI SPECIALTY GROUP, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty