Healthcare Provider Details

I. General information

NPI: 1619643608
Provider Name (Legal Business Name): CARDIOVASCULAR ASC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2021
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 PINELLAS ST STE 260
CLEARWATER FL
33756-3367
US

IV. Provider business mailing address

455 PINELLAS ST STE 400
CLEARWATER FL
33756-3356
US

V. Phone/Fax

Practice location:
  • Phone: 727-449-9891
  • Fax: 727-451-1610
Mailing address:
  • Phone: 727-445-1992
  • Fax: 727-445-1993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEVIN B MAIR
Title or Position: CEO
Credential:
Phone: 727-445-1992