Provider Demographics
NPI:1851552665
Name:COMPLETE CARDIOLOGY CARE, P.A.
Entity Type:Organization
Organization Name:COMPLETE CARDIOLOGY CARE, P.A.
Other - Org Name:ERIC L.S. LO, MD., PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HUIJIAN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-672-1023
Mailing Address - Street 1:PO BOX 291427
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-1427
Mailing Address - Country:US
Mailing Address - Phone:386-672-1023
Mailing Address - Fax:386-263-2996
Practice Address - Street 1:1240 W GRANADA BLVD FL 2
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5915
Practice Address - Country:US
Practice Address - Phone:386-672-1023
Practice Address - Fax:386-263-2996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-24
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72993207R00000X, 305S00000X
FLME112914207RC0000X
FLME101341207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty
No305S00000XManaged Care OrganizationsPoint of ServiceGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL38047DMedicare UPIN
FLAL778Medicare PIN