1588718910 NPI number — ADVANCED CARDIOVASCULAR CONSULTANTS,SC

Table of content: (NPI 1588718910)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588718910 NPI number — ADVANCED CARDIOVASCULAR CONSULTANTS,SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED CARDIOVASCULAR CONSULTANTS,SC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588718910
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2200 52ND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOLINE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61265-6363
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-788-7522
Provider Business Mailing Address Fax Number:
309-788-7562

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 52ND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOLINE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61265-6363
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-788-7522
Provider Business Practice Location Address Fax Number:
309-788-7562
Provider Enumeration Date:
01/23/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LABROO
Authorized Official First Name:
AJAY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
309-788-7522

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  36084756 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 047388 . This is a "HEALTH ALLIANCE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036084756 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 08132070 . This is a "BCBC OF IL PROV#" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 98576 . This is a "BCBS OF IA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0283911 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".