NPIMap

Organization Active NPI

Venice Cardiovascular Associates PL

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Venice, FL
National Provider Identifier
1316982473
Registry record updated Jun 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
Legal business name
VENICE CARDIOVASCULAR ASSOCIATES PL
Practice address
706 The Rialto
Venice, FL 34285-3524
Phone
(941) 484-8004
Fax
(941) 484-8869
NPI assigned
Jun 20, 2006
Last updated
Jun 5, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Treva D. Widdis
Title
Administrator
Phone
(352) 787-9838

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X NU Primary

Addresses

Primary practice location

706 The Rialto
Venice, FL 34285-3524

Mailing address

700 Doctors CT
Leesburg, FL 34748-7314
Phone (352) 787-9838

Other identifiers 2

IdentifierTypeStateIssuer
34655OtherFLBCBS OF FLORIDA
267915900MedicaidFL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591315200000",
    "number": "1316982473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 DOCTORS CT",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347487314",
            "telephone_number": "352-787-9838",
            "fax_number": "352-787-8705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "706 THE RIALTO",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "342853524",
            "telephone_number": "941-484-8004",
            "fax_number": "941-484-8869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VENICE CARDIOVASCULAR ASSOCIATES PL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-20",
        "last_updated": "2020-06-05",
        "certification_date": "2020-06-05",
        "status": "A",
        "authorized_official_last_name": "WIDDIS",
        "authorized_official_first_name": "TREVA",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "352-787-9838"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF FLORIDA",
            "identifier": "34655",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "267915900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Venice, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.