Organization
LEESBURG CARDIOVASCULAR ASSOCIATES LLC
Active
Parent organization
FLORIDA HEART AND VASCULAR SURGEONS, PA
Organization subpart
Yes
Provider details
NPI number
Legal business name
FLORIDA HEART AND VASCULAR SURGEONS, PA
Authorized official
TREVA D WIDDIS (ADMINISTRATOR)
(352) 787-9838
Entity
Organization
Contact information
Practice address
700 DOCTORS CT, LEESBURG, FL 34748-7314
(352) 787-9838
(352) 787-8705
Mailing address
700 DOCTORS CT, LEESBURG, FL 34748-7314
(352) 787-9838
(352) 787-8705
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21949
BCBS OF FLORIDA
FL
05
—
255785100
—
FL
Enumeration date
06/20/2006
Last updated
06/29/2020
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