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General NPI Number Information
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NPI Number | 1508818592
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Entity Type | Organization
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Legal Business Name | PARK AVENUE HEART AND VASCULAR CENTER LLC
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 08/06/2008
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Provider Practice Location Address
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Address Line | 1824 KING ST SUITE 250
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City | JACKSONVILLE
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State | FL
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Zip | 32204-4735
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Country | US
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Telephone | 904-388-1820
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Fax | 904-388-1827
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Provider Business Mailing Address
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Address Line | 562 PARK ST SUITE 310
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City | JACKSONVILLE
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State | FL
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Zip | 32204-2918
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Country | US
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Telephone | 904-633-2021
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Fax | 904-633-9793
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | MRS. CONNIE SUE CRAWFORD
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Credential |
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Telephone | 904-633-2021
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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 |
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