Provider Demographics
NPI:1699958769
Name:VERO BEACH CARDIOVASCULAR ASSOCIATES PA
Entity type:Organization
Organization Name:VERO BEACH CARDIOVASCULAR ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MIDWALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-567-4311
Mailing Address - Street 1:PO BOX 864334
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-4334
Mailing Address - Country:US
Mailing Address - Phone:772-567-4311
Mailing Address - Fax:561-357-0869
Practice Address - Street 1:1000 36TH ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4862
Practice Address - Country:US
Practice Address - Phone:772-567-4311
Practice Address - Fax:561-357-0869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN2306OtherRAIL ROAD MEDICARE
FL280445000Medicaid
FL21488OtherBCBS
FL280445000Medicaid
FL=========OtherEIN