Provider Demographics
NPI:1841745718
Name:SOUTH TAMPA CARDIOLOGY LLC
Entity Type:Organization
Organization Name:SOUTH TAMPA CARDIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:C
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-495-8002
Mailing Address - Street 1:301 W PLATT ST STE 325
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2292
Mailing Address - Country:US
Mailing Address - Phone:813-870-1747
Mailing Address - Fax:813-343-6089
Practice Address - Street 1:3704 W EUCLID AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-8725
Practice Address - Country:US
Practice Address - Phone:813-870-1747
Practice Address - Fax:813-343-6089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME112693207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012071400Medicaid
FL012071400Medicaid