Provider Demographics
NPI:1912930561
Name:ORLANDO CARDIOVASCULAR CENTER LLLP
Entity Type:Organization
Organization Name:ORLANDO CARDIOVASCULAR CENTER LLLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:TART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-425-6226
Mailing Address - Street 1:1405 S ORANGE AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2154
Mailing Address - Country:US
Mailing Address - Phone:407-425-6226
Mailing Address - Fax:407-422-0115
Practice Address - Street 1:1405 S ORANGE AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2154
Practice Address - Country:US
Practice Address - Phone:407-425-6226
Practice Address - Fax:407-422-0115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCCR 2251293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE6750Medicare ID - Type Unspecified