MEDICARE: HEART STUDY 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	2471S1302X	Sonography Radiologic Technologist	P97000031620	FL
2	246XS1301X	Sonography Specialist/Technologist Cardiovascular	P97000031620	FL
3	261QR0200X	Radiology Clinic/Center	P97000031620	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	470000208	OTHER	FL	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	27291	OTHER	FL	WELLCARE
2	7975214	OTHER	FL	AETNA
3	208707	OTHER	FL	AMERIGROUP
4	V2099	OTHER	FL	BCBS
6	9481963	OTHER	FL	CIGNA
7	40424912	OTHER	FL	UNITED HEALTHCARE
8	9721261	OTHER	FL	GHI

General Provider Information

NPI Number	:	1275590192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEART STUDY CENTER INC

Provider Business Mailing Address
First Line	:	755 W STATE ROAD 434
Second Line	:	SUITE A
City	:	LONGWOOD
State	:	FL
Zip	:	32750-5156
Country	:	US
Telephone Number	:	407-834-1151
Fax Number	:	407-834-2232

Provider Business Practice Location Address
First Line	:	755 W STATE ROAD 434
Second Line	:	SUITE A
City	:	LONGWOOD
State	:	FL
Zip	:	32750-5156
Country	:	US
Telephone Number	:	407-834-1151
Fax Number	:	407-834-2232

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	MRS. BLANCA M RODRIGUEZ
Credential	:
Telephone Number	:	407-834-1151

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	11/09/2010

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Directions to “HEART STUDY CENTER INC ” Practice Location

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