1750571915 NPI number — ADVANCED CARDIOVASCULAR SPECIALISTS PSC

Table of content: (NPI 1750571915)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750571915 NPI number — ADVANCED CARDIOVASCULAR SPECIALISTS PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED CARDIOVASCULAR SPECIALISTS PSC
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:
1750571915
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 221197
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40252-1197
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-425-5614
Provider Business Mailing Address Fax Number:
502-425-5633

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3801 SPRINGHURST BLVD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40241-6137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-425-5614
Provider Business Practice Location Address Fax Number:
502-425-5633
Provider Enumeration Date:
07/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SINGER
Authorized Official First Name:
IGOR
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN AND OWNER
Authorized Official Telephone Number:
502-425-5614

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  25392 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 50016391 . This is a "PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100006010 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200879220 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2864649 . This is a "PASSPORT ADVANTAGE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000487197 . This is a "ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".




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