Provider Demographics
NPI:1770108706
Name:ANSAARIE CARDIAC & ENDOVASCULAR CENTER OF EXCELLENCE
Entity type:Organization
Organization Name:ANSAARIE CARDIAC & ENDOVASCULAR CENTER OF EXCELLENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IMRAAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANSAARIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-232-9203
Mailing Address - Street 1:209 PINEHURST POINTE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-3703
Mailing Address - Country:US
Mailing Address - Phone:386-232-9203
Mailing Address - Fax:386-222-3064
Practice Address - Street 1:1301 PLANTATION ISLAND DR S STE 302A
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-3117
Practice Address - Country:US
Practice Address - Phone:386-232-9203
Practice Address - Fax:386-222-3064
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANSAARIE CARDIAC & ENDOVASCULAR CENTER OF EXCELLENCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAME121178OtherSTATE LICENSE