Provider Demographics
NPI:1285881946
Name:PALM COAST CARDIOVASCULAR INSTITUTE PL
Entity type:Organization
Organization Name:PALM COAST CARDIOVASCULAR INSTITUTE PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMENIC
Authorized Official - Middle Name:
Authorized Official - Last Name:MARINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-586-4404
Mailing Address - Street 1:19 OLD KINGS RD N STE C101
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-8261
Mailing Address - Country:US
Mailing Address - Phone:386-446-6540
Mailing Address - Fax:386-447-7148
Practice Address - Street 1:19 OLD KINGS RD N STE C101
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8261
Practice Address - Country:US
Practice Address - Phone:386-446-6540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-25
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80454174400000X
261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty