1376770412 NPI number — ADVANCED CARDIOVASCULAR INSTITUTE, PLC ANH N. CAMPBELL SOLEMBR

Table of content: (NPI 1376770412)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376770412 NPI number — ADVANCED CARDIOVASCULAR INSTITUTE, PLC ANH N. CAMPBELL SOLEMBR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED CARDIOVASCULAR INSTITUTE, PLC ANH N. CAMPBELL SOLEMBR
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:
ADVANCED CARDIOVASCULAR INSTITUTE, PLC
Provider Other Organization Name Type Code:
4
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:
1376770412
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5215 MONTICELLO AVENUE
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
WILLIAMSBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23188
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-229-1440
Provider Business Mailing Address Fax Number:
757-253-7590

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5215 MONTICELLO AVENUE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
WILLIAMSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23188
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-229-1440
Provider Business Practice Location Address Fax Number:
757-253-7590
Provider Enumeration Date:
06/16/2009

Additional Information

Authorized Official

Authorized Official Last Name:
CAMPBELL
Authorized Official First Name:
ANH
Authorized Official Middle Name:
N.
Authorized Official Title or Position:
PHYSICIAN/PRACTICE OWNER
Authorized Official Telephone Number:
757-229-1440

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  010105035 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: C10960 . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: C09253 . This is a "MEDICARE PTN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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