Basic Information
| Provider Information | |||||||||
| NPI: | 1013977941 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LANGHORNE CARDIOLOGY CONSULTANTS, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CARDIOLOGY CONSULTANTS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1717 NORTH E STREET | ||||||||
| Address2: | SUITE 333 | ||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325016376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504441717 | ||||||||
| FaxNumber: | 8504441797 | ||||||||
| Practice Location | |||||||||
| Address1: | 1717 NORTH E STREET | ||||||||
| Address2: | SUITE 331 | ||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504441717 | ||||||||
| FaxNumber: | 8504441755 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2006 | ||||||||
| LastUpdateDate: | 06/26/2018 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | AYCOCK | ||||||||
| AuthorizedOfficialFirstName: | GEORGE | ||||||||
| AuthorizedOfficialMiddleName: | RAMON | ||||||||
| AuthorizedOfficialTitleorPosition: | PAST PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8504441772 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | M.D., F.A.C.C. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | AL | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207RI0011X | FL | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 528300430 | 05 | AL | MEDICAID | 001675500 | 05 | FL | MEDICAID |