Provider Demographics
NPI:1154701365
Name:HEART AND VASCULAR ASSOCIATES OF TAMPA LLC
Entity type:Organization
Organization Name:HEART AND VASCULAR ASSOCIATES OF TAMPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TALAL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-280-0202
Mailing Address - Street 1:PO BOX 4706
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33677-4706
Mailing Address - Country:US
Mailing Address - Phone:813-280-0202
Mailing Address - Fax:813-280-0203
Practice Address - Street 1:2715 N MACDILL AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-2205
Practice Address - Country:US
Practice Address - Phone:813-280-0202
Practice Address - Fax:813-280-0203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-03
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015515800Medicaid
FL009WYOtherBLUE CROSS
FLII663AMedicare PIN
FL015515800Medicaid
FLII663AMedicare PIN