Provider Demographics
NPI:1184892739
Name:OUR HEART AND VASCULAR CENTER LLC
Entity type:Organization
Organization Name:OUR HEART AND VASCULAR CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GOPAL
Authorized Official - Middle Name:KISHORE
Authorized Official - Last Name:CHALAVARYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-869-5100
Mailing Address - Street 1:13740 OFFICE PARK CT
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-7145
Mailing Address - Country:US
Mailing Address - Phone:727-869-5100
Mailing Address - Fax:727-869-5166
Practice Address - Street 1:13740 OFFICE PARK CT
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7145
Practice Address - Country:US
Practice Address - Phone:727-869-5100
Practice Address - Fax:727-869-5166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-18
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center