Healthcare Provider Details

I. General information

NPI: 1114095890
Provider Name (Legal Business Name): SOUTH COUNTY HEART GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 JACARANDA BLVD
VENICE FL
34292-4521
US

IV. Provider business mailing address

1225 JACARANDA BLVD
VENICE FL
34292-4521
US

V. Phone/Fax

Practice location:
  • Phone: 941-492-5666
  • Fax: 941-497-2331
Mailing address:
  • Phone: 941-492-5666
  • Fax: 941-497-2331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. WILLIAM J CORIN
Title or Position: PRERSIDENT
Credential: M.D.
Phone: 941-492-5666