MEDICARE: HEART CENTER OF THE TREASURE COAST

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	261QM2500X	Medical Specialty Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	38558	OTHER	FL	BCBS FLORIDA PROVIDER #

General Provider Information

NPI Number	:	1407891104
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEART CENTER OF THE TREASURE COAST

Provider Business Mailing Address
First Line	:	330 17TH ST
Second Line	:	SUITE E
City	:	VERO BEACH
State	:	FL
Zip	:	32960-5690
Country	:	US
Telephone Number	:	772-562-6161
Fax Number	:	772-562-5568

Provider Business Practice Location Address
First Line	:	330 17TH ST
Second Line	:	SUITE E
City	:	VERO BEACH
State	:	FL
Zip	:	32960-5690
Country	:	US
Telephone Number	:	772-562-6161
Fax Number	:	772-562-5568

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. CHARLES N. CELANO
Credential	:	M.D.
Telephone Number	:	772-562-6161

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	02/03/2010

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Directions to “HEART CENTER OF THE TREASURE COAST ” Practice Location

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