Provider Demographics
NPI:1588768147
Name:ST AUGUSTINE CARDIOLOGY ASSOCIATES PA
Entity type:Organization
Organization Name:ST AUGUSTINE CARDIOLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT MD
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:N
Authorized Official - Last Name:SIGNOR
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:904-824-1776
Mailing Address - Street 1:201 HEALTH PARK BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086
Mailing Address - Country:US
Mailing Address - Phone:904-824-1776
Mailing Address - Fax:904-825-1270
Practice Address - Street 1:201 HEALTH PARK BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086
Practice Address - Country:US
Practice Address - Phone:904-824-1776
Practice Address - Fax:904-825-1270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL045290400Medicaid
09076WMedicare ID - Type Unspecified
FL045290400Medicaid