MEDICARE: PEDIATRIC HEART ASSOCIATES PA

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	174400000X	Specialist

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	:	1831305978
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC HEART ASSOCIATES PA

Provider Business Mailing Address
First Line	:	3801 HOLLYWOOD BLVD
Second Line	:	SUITE 350
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6758
Country	:	US
Telephone Number	:	954-966-6216
Fax Number	:

Provider Business Practice Location Address
First Line	:	3801 HOLLYWOOD BLVD
Second Line	:	SUITE 350
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6758
Country	:	US
Telephone Number	:	954-966-6216
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. VICENTE LEMES
Credential	:	M.D.
Telephone Number	:	954-966-8667

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	09/07/2011

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