Provider Demographics
NPI:1992830731
Name:HEALTH CENTRAL EKG SPECIALISTS, LLC
Entity Type:Organization
Organization Name:HEALTH CENTRAL EKG SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WENTZELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-877-2111
Mailing Address - Street 1:11140 W COLONIAL DR STE 1
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-3300
Mailing Address - Country:US
Mailing Address - Phone:407-877-2111
Mailing Address - Fax:
Practice Address - Street 1:11140 W COLONIAL DR STE 1
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-3300
Practice Address - Country:US
Practice Address - Phone:407-877-2111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5484Medicare ID - Type Unspecified