Provider Demographics
NPI:1487757092
Name:CARDIOVASCULAR ASSOCIATES OF JACKSONVILLE PA
Entity type:Organization
Organization Name:CARDIOVASCULAR ASSOCIATES OF JACKSONVILLE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:KANTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-399-4120
Mailing Address - Street 1:3599 UNIVERSITY BLVD SOUTH
Mailing Address - Street 2:SUITE 913
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4269
Mailing Address - Country:US
Mailing Address - Phone:904-399-4120
Mailing Address - Fax:904-399-5940
Practice Address - Street 1:3599 UNIVERSITY BLVD SOUTH
Practice Address - Street 2:SUITE 913
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4269
Practice Address - Country:US
Practice Address - Phone:904-399-4120
Practice Address - Fax:904-399-5940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0609919Medicaid
E11906Medicare UPIN
FLAM007Medicare PIN