MEDICARE: CARDIOLOGY ASSOCIATES OF GAINESVILLE

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		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528206638
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIOLOGY ASSOCIATES OF GAINESVILLE

Provider Business Mailing Address
First Line	:	4645 NW 8TH AVE
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32605-4524
Country	:	US
Telephone Number	:	352-375-1212
Fax Number	:	352-371-4650

Provider Business Practice Location Address
First Line	:	3140 NW MEDICAL CENTER LN STE 140
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-4735
Country	:	US
Telephone Number	:	386-487-0118
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS OFFICE MANAGER
Name	:	MRS. NORMA J. WYCKOFF
Credential	:
Telephone Number	:	352-375-1212

Provider Enumeration Date	:	01/27/2009
Last Update Date	:	01/18/2012

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Directions to “CARDIOLOGY ASSOCIATES OF GAINESVILLE ” Practice Location

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