MEDICARE: CARDIAC CARE CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	ME78625	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	47147	OTHER	FL	BLUE CROSS/BLUE SHIELD FL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023029154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIAC CARE CENTER INC

Provider Business Mailing Address
First Line	:	700 ZEAGLER DR STE 2
Second Line	:
City	:	PALATKA
State	:	FL
Zip	:	32177-3826
Country	:	US
Telephone Number	:	386-326-3633
Fax Number	:	386-312-5080

Provider Business Practice Location Address
First Line	:	700 ZEAGLER DR
Second Line	:	SUITE 2
City	:	PALATKA
State	:	FL
Zip	:	32177
Country	:	US
Telephone Number	:	386-326-3633
Fax Number	:	386-312-5080

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	KRYSTAL DREYER
Credential	:
Telephone Number	:	386-326-3633

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	04/15/2026

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Directions to “CARDIAC CARE CENTER INC ” Practice Location

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