Basic Information
| Provider Information | |||||||||
| NPI: | 1285691477 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COASTAL CARDIOLOGY CONSULTANTS PA | ||||||||
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| OtherOrganizationName: | THE HEART & VASCULAR INSTITUTE OF FLORIDA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1840 MEASE DRIVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SAFETY HARBOR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34695 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7277248611 | ||||||||
| FaxNumber: | 7277120499 | ||||||||
| Practice Location | |||||||||
| Address1: | 1840 MEASE DR | ||||||||
| Address2: | STE 200 | ||||||||
| City: | SAFETY HARBOR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34695 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7277248611 | ||||||||
| FaxNumber: | 7277120499 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2006 | ||||||||
| LastUpdateDate: | 02/03/2015 | ||||||||
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| AuthorizedOfficialLastName: | KAMBER | ||||||||
| AuthorizedOfficialFirstName: | STEVE | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7277248611 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 207RC000X | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 271265200 | 05 | FL | MEDICAID |