Provider Demographics
NPI:1548479579
Name:CARDIOLOGY CONSULTANTS
Entity type:Organization
Organization Name:CARDIOLOGY CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-896-0054
Mailing Address - Street 1:2320 N ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-5506
Mailing Address - Country:US
Mailing Address - Phone:407-896-0054
Mailing Address - Fax:407-898-4463
Practice Address - Street 1:2320 N ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-5506
Practice Address - Country:US
Practice Address - Phone:407-896-0054
Practice Address - Fax:407-898-4463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3516-32471R0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471R0002XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiation TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061472600Medicaid
FL035671900Medicaid
FL99507OtherBLUE CROSS GROUP
FL039549800Medicaid
FL048179300Medicaid
FL060053196Medicare ID - Type UnspecifiedROBERT BOSWELL RAILROAD M
FL060056403Medicare ID - Type UnspecifiedROBERT ROTHBARD RAILROAD
FL048179300Medicaid
FL035671900Medicaid
FL060053197Medicare ID - Type UnspecifiedJAMES BOLEN RAILROAD MEDI
FL060056404Medicare ID - Type UnspecifiedVAN DEN BERG RAILROAD
FL99507Medicare PIN
FLD55480Medicare UPIN
FLB71902Medicare UPIN
FL47318Medicare ID - Type UnspecifiedROBERT BOSWELL,M.D.
FL061472600Medicaid
FL48856Medicare ID - Type UnspecifiedJAMES BOLEN,M.D.
FL08208Medicare ID - Type UnspecifiedEGERGTON VAN DEN BERG,M.D