Provider Demographics
NPI:1962450643
Name:HEART AND VASCULAR CENTER OF VENICE
Entity Type:Organization
Organization Name:HEART AND VASCULAR CENTER OF VENICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BASNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-497-5511
Mailing Address - Street 1:901 VENETIA BAY BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-8044
Mailing Address - Country:US
Mailing Address - Phone:941-497-5511
Mailing Address - Fax:941-492-2221
Practice Address - Street 1:901 VENETIA BAY BLVD STE 300
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-8044
Practice Address - Country:US
Practice Address - Phone:941-497-5511
Practice Address - Fax:941-492-2221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45807OtherBLUE CROSS BLUE SHIELD
FLCH6939Medicare ID - Type UnspecifiedRAILROAD MEDICARE
FL45807OtherBLUE CROSS BLUE SHIELD
FL261401400Medicaid