Basic Information
| Provider Information | |||||||||
| NPI: | 1104026467 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FLORIDA CARDIOLOGY ASSOCIATES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2410 NORTHSIDE DR | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337612236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278486400 | ||||||||
| FaxNumber: | 7278486200 | ||||||||
| Practice Location | |||||||||
| Address1: | 3543 LITTLE ROAD | ||||||||
| Address2: | STE A | ||||||||
| City: | NEW PORT RICHEY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278486400 | ||||||||
| FaxNumber: | 7278486200 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2007 | ||||||||
| LastUpdateDate: | 05/07/2019 | ||||||||
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| AuthorizedOfficialLastName: | AGARWAL | ||||||||
| AuthorizedOfficialFirstName: | SUDHIR | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER / PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 7278486400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 251732 | 01 | FL | WELLCARE | OTHER | 98688 | 01 | FL | BCBS OF FL | OTHER | 003208400 | 05 | FL | MEDICAID | DN7755 | 01 | RAILROAD MEDICARE | OTHER |