Basic Information
| Provider Information | |||||||||
| NPI: | 1801198023 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEST FLORIDA CARDIOLOGY NETWORK, LLC | ||||||||
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| OtherOrganizationName: | THE HEART INSTITUTE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6006 49TH ST N | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SAINT PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337092148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274902100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6006 49TH ST N | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SAINT PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337092148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274902100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2010 | ||||||||
| LastUpdateDate: | 08/30/2019 | ||||||||
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| AuthorizedOfficialLastName: | JOHANNESSAN | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP | ||||||||
| AuthorizedOfficialTelephone: | 7274902100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0001X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | 207RI0011X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207RC0000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.