Basic Information
| Provider Information | |||||||||
| NPI: | 1124276167 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTER FOR HEALTH OF CHARLOTTE PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1107 W MARION AVE | ||||||||
| Address2: | 116 | ||||||||
| City: | PUNTA GORDA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339505372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9416377000 | ||||||||
| FaxNumber: | 9416397576 | ||||||||
| Practice Location | |||||||||
| Address1: | 1107 W MARION AVE | ||||||||
| Address2: | 116 | ||||||||
| City: | PUNTA GORDA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339505372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9416377000 | ||||||||
| FaxNumber: | 9416397576 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2008 | ||||||||
| LastUpdateDate: | 05/12/2015 | ||||||||
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| AuthorizedOfficialLastName: | RUGGIERI | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9416377000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | ME0055973 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 97988 | 01 | FL | BCBS FL | OTHER |