Provider Demographics
NPI:1184888950
Name:FLORIDA CARDIAC CONSULTANTS, INC
Entity type:Organization
Organization Name:FLORIDA CARDIAC CONSULTANTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SPETSIOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-917-0060
Mailing Address - Street 1:PO BOX 25377
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277
Mailing Address - Country:US
Mailing Address - Phone:941-917-0060
Mailing Address - Fax:
Practice Address - Street 1:463 CARLTON ST
Practice Address - Street 2:
Practice Address - City:WAUCHULA
Practice Address - State:FL
Practice Address - Zip Code:33873-3400
Practice Address - Country:US
Practice Address - Phone:863-767-0660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL98788OtherBLUE CROSS/BLUE SHIELD
FLCA6910OtherRAILROAD MEDICARE
FL057520800Medicaid
FL057520800Medicaid