Provider Demographics
NPI:1215238563
Name:HEART CENTER OF SAINT AUGUSTINE, PA
Entity type:Organization
Organization Name:HEART CENTER OF SAINT AUGUSTINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSCIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISHNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIKARIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-825-4333
Mailing Address - Street 1:238 FIDDLERS POINT DR
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-6133
Mailing Address - Country:US
Mailing Address - Phone:904-825-4333
Mailing Address - Fax:904-825-4248
Practice Address - Street 1:301 HEALTH PARK BLVD STE 329
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5771
Practice Address - Country:US
Practice Address - Phone:904-825-4333
Practice Address - Fax:904-825-4248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0064435207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL060052505OtherRAILROAD MEDICARE
FL375418900Medicaid
25436AOtherMEDICARE PARTICIPATION ID
FL25436OtherFL BLUE CROSS BLUE SHIELD
25436AOtherMEDICARE PARTICIPATION ID