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General NPI Number Information
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NPI Number | 1083616437
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Entity Type | Organization
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Legal Business Name | MOFFITT HEART AND VASCULAR GROUP INC.
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Dates
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Enumeration Date | 08/15/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1000 N FRONT ST SUITE 200
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City | WORMLEYSBURG
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State | PA
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Zip | 17043-1034
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Country | US
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Telephone | 717-731-0101
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Fax | 717-441-0592
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Provider Business Mailing Address
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Address Line | 1000 N FRONT ST SUITE 200
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City | WORMLEYSBURG
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State | PA
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Zip | 17043-1034
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Country | US
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Telephone | 717-731-0101
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Fax | 717-441-0592
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Authorized Official
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Title or Position | CONTROLLER
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Name | MR. WILLIAM STROUSE
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Credential | MBA,CPA
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Telephone | 717-731-0101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State | PA
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