Provider Demographics
NPI:1013977941
Name:LANGHORNE CARDIOLOGY CONSULTANTS, INC.
Entity type:Organization
Organization Name:LANGHORNE CARDIOLOGY CONSULTANTS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PAST PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:RAMON
Authorized Official - Last Name:AYCOCK
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD, FACC
Authorized Official - Phone:850-444-1772
Mailing Address - Street 1:125 BAPTIST WAY STE 3A
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2274
Mailing Address - Country:US
Mailing Address - Phone:448-227-6604
Mailing Address - Fax:850-430-7144
Practice Address - Street 1:125 BAPTIST WAY STE 3A
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2274
Practice Address - Country:US
Practice Address - Phone:448-227-6604
Practice Address - Fax:504-307-1448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL207RI0011X
FL207RI0011X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL528300430Medicaid
FL001675500Medicaid
FL99109Medicare PIN
AL102G705828Medicare UPIN