=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912930561
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORLANDO CARDIOVASCULAR CENTER LLLP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2006
-----------------------------------------------------
Last Update Date | 04/18/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1405 S ORANGE AVE SUITE 120
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32806-2154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-425-6226
-----------------------------------------------------
Fax | 407-422-0115
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1405 S ORANGE AVE SUITE 120
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32806-2154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-425-6226
-----------------------------------------------------
Fax | 407-422-0115
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ASSISTANT DIRECTOR
-----------------------------------------------------
Name | MRS. SANDRA A TART
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 407-425-6226
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 293D00000X
-----------------------------------------------------
Taxonomy Name | Physiological Laboratory
-----------------------------------------------------
License Number | HCCR 2251
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------