MEDICARE: ARRHYTHMIA AND CARDIOVASCULAR ASSOCIATES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician

General Provider Information

NPI Number	:	1215397203
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARRHYTHMIA AND CARDIOVASCULAR ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	2320 NORTH BLVD W STE A
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33837-8924
Country	:	US
Telephone Number	:	863-353-7858
Fax Number	:	863-508-6362

Provider Business Practice Location Address
First Line	:	2320 NORTH BLVD W STE A
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33837-8924
Country	:	US
Telephone Number	:	863-353-7858
Fax Number	:	863-508-6362

Authorized Official
Title or Position	:	OWNER
Name	:	LUIS E CARRILLO
Credential	:	MD
Telephone Number	:	863-353-7858

Provider Enumeration Date	:	03/03/2016
Last Update Date	:	03/03/2016

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