| Entity Name: | CARDIOLOGY CONSULTANTS, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 20 Oct 1997 (27 years ago) |
| Document Number: | P97000090128 |
| FEI/EIN Number | 593485170 |
| Address: | 2320 N. ORANGE AVE., ORLANDO, FL, 32804 |
| Mail Address: | 2320 N. ORANGE AVE., ORLANDO, FL, 32804 |
| ZIP code: | 32804 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1821241563 | 2008-10-28 | 2008-10-28 | 2320 N ORANGE AVE, ORLANDO, FL, 328045506, US | 2320 N ORANGE AVE, ORLANDO, FL, 328045506, US | |||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 407-896-0054 |
| Fax | 4078984463 |
Authorized person
| Name | DR. JAMES BOLEN |
| Role | CEO |
| Phone | 4078960054 |
Taxonomy
| Taxonomy Code | 2471N0900X - Nuclear Medicine Technology Radiologic Technologist |
| License Number | 3516-3 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS |
| Number | 08208 |
| State | FL |
| Issuer | BLUE CROSS GROUP |
| Number | 99507 |
| State | FL |
| Issuer | BLUE CROSS |
| Number | 47318 |
| State | FL |
| Issuer | BLUE CROSS |
| Number | 48856 |
| State | FL |
| Issuer | BLUE CROSS |
| Number | 05909 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CARDIOLOGY CONSULTANTS, P.A. 401(K) PROFIT SHARING PLAN | 2020 | 593485170 | 2021-10-07 | CARDIOLOGY CONSULTANTS, P.A. | 11 | |||||||||||||
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| CARDIOLOGY CONSULTANTS, P.A. 401(K) PROFIT SHARING PLAN | 2020 | 593485170 | 2021-10-07 | CARDIOLOGY CONSULTANTS, P.A. | 2 | |||||||||||||
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| CARDIOLOGY CONSULTANTS, P.A. 401(K) PROFIT SHARING PLAN | 2019 | 593485170 | 2020-07-09 | CARDIOLOGY CONSULTANTS, P.A. | 35 | |||||||||||||
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| CARDIOLOGY CONSULTANTS, P.A. 401(K) PROFIT SHARING PLAN | 2018 | 593485170 | 2019-10-15 | CARDIOLOGY CONSULTANTS, P.A. | 30 | |||||||||||||
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| Name | Role | Address |
|---|---|---|
| TILLMAN JOSEPH | Agent | 2320 N ORANGE AVENUE, ORLANDO, FL, 32804 |
| Name | Role | Address |
|---|---|---|
| van den Berg Egerton KJr. | President | 2320 N. ORANGE AVE., ORLANDO, FL, 32804 |
| Name | Role | Address |
|---|---|---|
| Rothbard Robert L | Vice President | 2320 N. ORANGE AVE., ORLANDO, FL, 32804 |
| Name | Role | Address |
|---|---|---|
| Bolen James L | Treasurer | 2 Isle of Sicily, Winter Park, FL, 32789 |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
