Basic Information
| Provider Information | |||||||||
| NPI: | 1497784599 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARDIOLOGY ASSOCIATES L.L.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 750 DESOTO AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKSVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346012814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527966721 | ||||||||
| FaxNumber: | 3527540375 | ||||||||
| Practice Location | |||||||||
| Address1: | 750 DESOTO AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKSVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346012814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527966721 | ||||||||
| FaxNumber: | 3527540375 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | AMARCHAND | ||||||||
| AuthorizedOfficialFirstName: | LINGAPPA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3527966721 | ||||||||
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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 | 207R00000X | ME68472 | FL | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | ME0021368 | FL | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0000X | ME82878 | FL | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 21313 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER | DA 1090 | 01 | FL | RAIL ROAD MEDICARE | OTHER | 7801420 | 01 | FL | AETNA | OTHER |