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General NPI Number Information
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NPI Number | 1659652303
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Entity Type | Organization
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Legal Business Name | MIDCOAST CARDIOVASCULAR ASSOCIATES
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Dates
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Enumeration Date | 09/07/2011
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Last Update Date | 03/01/2016
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Provider Practice Location Address
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Address Line | 220 S PALISADE DR SUITE # 101
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City | SANTA MARIA
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State | CA
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Zip | 93454-8902
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Country | US
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Telephone | 805-354-0112
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Fax | 805-354-0234
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Provider Business Mailing Address
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Address Line | 220 S PALISADE DR SUITE # 101
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City | SANTA MARIA
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State | CA
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Zip | 93454-8902
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Country | US
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Telephone | 805-354-0112
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Fax | 805-354-0234
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK L GINKEL
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Credential | MD
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Telephone | 805-354-0112
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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 | G71322
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | G71322
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License Number State | CA
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