Healthcare Provider Details

I. General information

NPI: 1013977941
Provider Name (Legal Business Name): LANGHORNE CARDIOLOGY CONSULTANTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 BAPTIST WAY STE 3A
PENSACOLA FL
32503-2274
US

IV. Provider business mailing address

125 BAPTIST WAY STE 3A
PENSACOLA FL
32503-2274
US

V. Phone/Fax

Practice location:
  • Phone: 448-227-6604
  • Fax: 504-307-1448
Mailing address:
  • Phone: 448-227-6604
  • Fax: 850-430-7144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: GEORGE RAMON AYCOCK JR.
Title or Position: PAST PRESIDENT
Credential: M.D., F.A.C.C.
Phone: 850-444-1772