Basic Information
| Provider Information | |||||||||
| NPI: | 1720045149 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE HEART GRP PL | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 07069 | ||||||||
| Address2: | |||||||||
| City: | FT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2394338888 | ||||||||
| FaxNumber: | 2394338819 | ||||||||
| Practice Location | |||||||||
| Address1: | 8540 COLLEGE PARKWAY | ||||||||
| Address2: | |||||||||
| City: | FT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2394338888 | ||||||||
| FaxNumber: | 2394338819 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LANGLEY | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR CEO | ||||||||
| AuthorizedOfficialTelephone: | 2394338888 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
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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 |
No ID Information.