=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518137827
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEST FLORIDA CARDIOVASCULAR CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2008
-----------------------------------------------------
Last Update Date | 11/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2676 W LAKE RD
-----------------------------------------------------
City | PALM HARBOR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34684-3120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-786-1000
-----------------------------------------------------
Fax | 727-786-1055
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 23021
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33623-2021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-823-2188
-----------------------------------------------------
Fax | 727-828-0723
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. VIMESH K MITHANI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 727-786-1000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | ME93842
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------