Provider Demographics
NPI:1386738425
Name:CHARLOTTE CARDIOVACULAR INSTITUTE, PA
Entity type:Organization
Organization Name:CHARLOTTE CARDIOVACULAR INSTITUTE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:HOTCHKISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACC
Authorized Official - Phone:931-629-5356
Mailing Address - Street 1:PO BOX 495069
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33949-5069
Mailing Address - Country:US
Mailing Address - Phone:941-629-5356
Mailing Address - Fax:941-629-4987
Practice Address - Street 1:4161 TAMIAMI TRL
Practice Address - Street 2:SUITE 701
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-9204
Practice Address - Country:US
Practice Address - Phone:941-629-5356
Practice Address - Fax:941-629-4987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81967207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH86447Medicare UPIN
FLH36785Medicare UPIN
FLK8744Medicare PIN