Provider Demographics
NPI: | 1033629027 |
---|---|
Name: | SOUTH FLORIDA CARDIOLOGY ASSOCIATES LLC |
Entity type: | Organization |
Organization Name: | SOUTH FLORIDA CARDIOLOGY ASSOCIATES LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DIRECTOR OF OPERATIONS |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ALICIA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | LEDO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 786-256-9657 |
Mailing Address - Street 1: | 6101 BLUE LAGOON DR STE 200 |
Mailing Address - Street 2: | |
Mailing Address - City: | MIAMI |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33126-3168 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 305-500-2000 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4125 TAMIAMI TRL S UNIT 2 |
Practice Address - Street 2: | |
Practice Address - City: | VENICE |
Practice Address - State: | FL |
Practice Address - Zip Code: | 34293-5109 |
Practice Address - Country: | US |
Practice Address - Phone: | 941-584-9201 |
Practice Address - Fax: | 941-584-9202 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2017-10-04 |
Last Update Date: | 2024-06-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |