Provider Demographics
NPI:1881776995
Name:OSCEOLA CARDIO-PULMONARY CLINIC DC DAS MD PA
Entity type:Organization
Organization Name:OSCEOLA CARDIO-PULMONARY CLINIC DC DAS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DINES
Authorized Official - Middle Name:C
Authorized Official - Last Name:DAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-846-1044
Mailing Address - Street 1:901 E OAK ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-5837
Mailing Address - Country:US
Mailing Address - Phone:407-846-1044
Mailing Address - Fax:407-846-3523
Practice Address - Street 1:901 E OAK ST
Practice Address - Street 2:SUITE A
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5837
Practice Address - Country:US
Practice Address - Phone:407-846-1044
Practice Address - Fax:407-846-3523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260689500Medicaid
FL99360Medicare PIN