Provider Demographics
NPI:1881686459
Name:PASCO CARDIOLOGY CENTER INC
Entity Type:Organization
Organization Name:PASCO CARDIOLOGY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FONG MEI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-868-5404
Mailing Address - Street 1:14153 YOSEMITE DR STE 202
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-6575
Mailing Address - Country:US
Mailing Address - Phone:727-868-5404
Mailing Address - Fax:727-863-1787
Practice Address - Street 1:14153 YOSEMITE DR STE 202
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667
Practice Address - Country:US
Practice Address - Phone:727-868-5404
Practice Address - Fax:727-863-1787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376848100Medicaid
33448Medicare PIN
33448AMedicare PIN
33448CMedicare PIN