MEDICARE: COMPLETE CARDIOLOGY CARE, P.A.

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	ME112914	FL
2	207RC0001X	Clinical Cardiac Electrophysiology Physician	ME101341	FL
3	305S00000X	Point of Service	ME72993	FL
4	207R00000X	Internal Medicine Physician	ME72993	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851552665
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPLETE CARDIOLOGY CARE, P.A.

Provider Business Mailing Address
First Line	:	PO BOX 291427
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32129-1427
Country	:	US
Telephone Number	:	386-672-1023
Fax Number	:	386-263-2996

Provider Business Practice Location Address
First Line	:	1240 W GRANADA BLVD FL 2
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-5915
Country	:	US
Telephone Number	:	386-672-1023
Fax Number	:	386-263-2996

Authorized Official
Title or Position	:	OWNER
Name	:	HUIJIAN JAMES WANG
Credential	:	MD
Telephone Number	:	386-672-1023

Provider Enumeration Date	:	06/24/2008
Last Update Date	:	06/02/2022

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Directions to “COMPLETE CARDIOLOGY CARE, P.A. ” Practice Location

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