=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952002693
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEARTNVASCULAR
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2023
-----------------------------------------------------
Last Update Date | 05/08/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1136 BRYN MAWR AVE
-----------------------------------------------------
City | LAKE WALES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33853-4304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-929-7656
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8314 TIVOLI DR
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32836-8776
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-760-8852
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. OJI JOSEPH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 407-760-8852
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------