Provider Demographics
NPI:1104873405
Name:CARDIOVASCULAR HEALTH CONSULTANTS PA
Entity type:Organization
Organization Name:CARDIOVASCULAR HEALTH CONSULTANTS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PRESTON
Authorized Official - Middle Name:T
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-332-5755
Mailing Address - Street 1:13575 NW 1ST LN STE 20
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-3735
Mailing Address - Country:US
Mailing Address - Phone:352-332-5755
Mailing Address - Fax:855-964-1167
Practice Address - Street 1:13575 NW 1ST LN STE 20
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:FL
Practice Address - Zip Code:32669-3735
Practice Address - Country:US
Practice Address - Phone:352-332-5755
Practice Address - Fax:855-964-1167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS1027207OtherAVMED GROUP
DG3096OtherRAILROAD MEDICARE
FL24544OtherBLUE CROSS BLUE SHIELD