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

Table of Contents

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:
Provider Other Organization Name Type Code:
6
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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