LEWIS & KLANCKE CARDIOLOGY PA (NPI# 1669589263) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669589263 |
| Entity Type | Organization |
| Organization Name | LEWIS & KLANCKE CARDIOLOGY PA |
| Other Organization Name | DAYTONA HEART GROUP |
| Practice Address |
695 N Clyde Morris Blvd Daytona Beach FL 32114 |
| Practice Telephone | 3862588722 |
| Practice Fax Number | 3862589443 |
| Mailing Telephone | 3862588722 |
| Mailing Fax Number | 3862588659 |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2020-07-09 |
| Authorized Official Name | MR. ROOSEVELT D HARRIS (OFFICE MANAGER) |
| Authorized Official Telephone | 3862588722 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RC0001X |
Internal Medicine Specialization: Clinical Cardiac Electrophysiology |
Allopathic & Osteopathic Physicians | ||
| N | 207UN0901X |
Nuclear Medicine Specialization: Nuclear Cardiology |
Allopathic & Osteopathic Physicians | ||
| N | 207RI0011X |
Internal Medicine Specialization: Interventional Cardiology |
Allopathic & Osteopathic Physicians | ||
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 2086S0129X |
Surgery Specialization: Vascular Surgery |
FL | Allopathic & Osteopathic Physicians | |
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | BC/BS | 99279 | 01 |
| FL | 378998500 | 05 |
| Other Name | Type Code |
|---|---|
| Daytona Heart Group | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558405639 | Lewis & Klancke Cardiology Pa | Nuclear Medicine | 938 Saxon Blvd, Suite 101-c, Orange City, FL 32763-8305 | 2007-02-20 |
| Street Address |
695 N CLYDE MORRIS BLVD |
| City | DAYTONA BEACH |
| State | FL |
| Zip Code | 32114 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548239874 | Theresa Ann Purcell | Nurse Practitioner | 695 N Clyde Morris Blvd, Daytona Beach, FL 32114 | 2006-03-17 |
| 1750514154 | Umang Lalit Shah | Internal Medicine | 695 N Clyde Morris Blvd, Daytona Beach, FL 32114-2321 | 2009-09-01 |
| 1487887295 | Vincent Glenn Peterson | Internal Medicine | 695 N Clyde Morris Blvd, Daytona Beach, FL 32114-2321 | 2009-08-26 |
| 1467643213 | Pedro Rafael Cox-alomar | Internal Medicine | 695 N Clyde Morris Blvd, Daytona Beach, FL 32114-2321 | 2007-08-07 |
| 1528266939 | Roger K Lewis | Internal Medicine | 695 N Clyde Morris Blvd, Daytona Beach, FL 32114-2321 | 2007-07-06 |
| 1346457876 | Cynthia C. Davenport | Physician Assistant | 695 N Clyde Morris Blvd, Daytona Beach, FL 32114-2321 | 2007-05-16 |
| 1891907671 | Nancy S Mather | Nurse Practitioner | 695 N Clyde Morris Blvd, Daytona Beach, FL 32114-2321 | 2007-05-04 |
| 1245363423 | Atlantic Cardiology Enterprises, Inc. | Nuclear Medicine | 695 N Clyde Morris Blvd, Daytona Beach, FL 32114-2321 | 2007-03-14 |
| 1316902612 | Glenn Hidalgo Rayos | Internal Medicine | 695 N Clyde Morris Blvd, Daytona Beach, FL 32114 | 2006-04-19 |
| 1194788117 | Barry Allen Kusnick | Internal Medicine | 695 N Clyde Morris Blvd, Daytona Beach, FL 32114-2321 | 2006-04-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376161380 | Evolution Health & Performance LLC | Physician Assistant | 244 S. Palmetto Ave, Daytona Beach, FL 32114 | 2020-07-07 |
| 1407480189 | Kierra Imani Kinsey | Behavior Technician | 1128-a Beville Rd, Daytona Beach, FL 32114 | 2020-03-02 |
| 1043776057 | Outreach Community Care Network Inc | Pharmacy | 240 N. Frederick Avenue, Daytona Beach, FL 32114 | 2019-02-14 |
| 1033681861 | Katherine Proppe | Specialist/Technologist | 1 Aerospace Blvd, Daytona Beach, FL 32114 | 2018-12-18 |
| 1841765047 | Anna L Smith | Nurse Practitioner | 339 Bill France Blvd Ste C, Daytona Beach, FL 32114 | 2018-10-04 |
| 1154806933 | Steve Anthony Lee | Family Medicine | 731 N. Clyde Morris Blvd, Daytona Beach, FL 32114 | 2018-09-27 |
| 1285116491 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 1348 W International Speedway Blvd Ste 2, Daytona Beach, FL 32114 | 2018-09-04 |
| 1770085656 | Merina Lee | Occupational Therapist | 1159 Australia Ave., Daytona Beach, FL 32114 | 2018-03-06 |
| 1346752755 | Hand & Upper Extremity Surgery of Daytona Beach, LLC | Non-Pharmacy Dispensing Site | 1241 Ridgewood Ave, Daytona Beach, FL 32114 | 2017-10-26 |
| 1104347053 | Harry Herman Blanke IIi | Family Medicine | 201 N Clyde Morris Blvd, Suite 200, Halifax Health Family Medicine Residency Program, Daytona Beach, FL 32114 | 2017-06-30 |
| Find all providers in zip 32114 | ||||
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043488661 | Huijian James Wang | Internal Medicine | 305 Memorial Medical Pkwy Ste 300, Daytona Beach, FL 32117-5170 | 2008-02-16 |
| 1225098981 | Kim Arlan Klancke | Internal Medicine | 655 N Clyde Morris Blvd, Daytona Beach, FL 32114-2321 | 2006-03-27 |
| 1417921701 | Humayun Jamidar | Internal Medicine | 311 N Clyde Morris Blvd Ste 320, Daytona Beach, FL 32114-2756 | 2006-02-14 |
| 1972591949 | Donald J. Stoner | Internal Medicine | 303 North Clyde Morris Blvd., Halifax Health Medical Center, Daytona Beach, FL 32114-2709 | 2005-10-12 |
| 1164948360 | Heart Rhythm Specialists At Daytona LLC | Internal Medicine | 305 Memorial Medical Pkwy Ste 300, Daytona Beach, FL 32117-5170 | 2017-08-18 |
| 1033635271 | Eric Lup-sing Lo M. D., P.a. | Internal Medicine | 305 Memorial Medical Pkwy, Daytona Beach, FL 32117-5168 | 2017-08-18 |
| 1871901793 | Florentino Alberto Lupercio Lopez | Internal Medicine | 305 Memorial Medical Pkwy Ste 300, Daytona Beach, FL 32117-5170 | 2014-07-23 |
| 1740559855 | Cardiology Physicians Memorial, LLC | Internal Medicine | 305 Memorial Medical Pkwy, Suite 301, Daytona Beach, FL 32117-5168 | 2011-12-19 |
| 1750514154 | Umang Lalit Shah | Internal Medicine | 695 N Clyde Morris Blvd, Daytona Beach, FL 32114-2321 | 2009-09-01 |
| 1487887295 | Vincent Glenn Peterson | Internal Medicine | 695 N Clyde Morris Blvd, Daytona Beach, FL 32114-2321 | 2009-08-26 |
| Find all providers in DAYTONA BEACH | ||||
| City | DAYTONA BEACH |
| Zip Code | 32114 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.