NPIMap

Organization Active NPI

Park Avenue Heart and Vascular Center LLC

  • Cardiovascular Disease Physician
  • Jacksonville, FL
National Provider Identifier
1508818592
Registry record updated Aug 6, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
PARK AVENUE HEART AND VASCULAR CENTER LLC
Practice address
1824 King St
Suite 250
Jacksonville, FL 32204-4735
Phone
(904) 388-1820
Fax
(904) 388-1827
NPI assigned
May 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2008

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

Authorized official

Name
Mrs. Connie Sue Crawford
Title
Credentialing Manager
Phone
(904) 633-2021

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RC0000X Primary

Addresses

Primary practice location

1824 King St
Suite 250
Jacksonville, FL 32204-4735

Mailing address

562 Park St
Suite 310
Jacksonville, FL 32204-2918
Phone (904) 633-2021

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

2300 Park Ave
Ste 101C
Orange Park, FL 32073
Phone (904) 264-0088

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217980800000",
    "number": "1508818592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "562 PARK ST",
            "address_2": "SUITE 310",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322042918",
            "telephone_number": "904-633-2021",
            "fax_number": "904-633-9793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1824 KING ST",
            "address_2": "SUITE 250",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044735",
            "telephone_number": "904-388-1820",
            "fax_number": "904-388-1827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK AVENUE HEART AND VASCULAR CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-17",
        "last_updated": "2008-08-06",
        "status": "A",
        "authorized_official_last_name": "CRAWFORD",
        "authorized_official_first_name": "CONNIE",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "904-633-2021",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2008; 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.