1487990727 NPI number — ADVANCE CARDIOLOGY, PC

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 1487990727 NPI number — ADVANCE CARDIOLOGY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCE CARDIOLOGY, PC
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:
1487990727
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
575 COAL VALLEY RD
Provider Second Line Business Mailing Address:
SOUTH HILLS MEDICAL BUILDING- SUITE 460
Provider Business Mailing Address City Name:
JEFFERSON HILLS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15025-3730
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-469-0600
Provider Business Mailing Address Fax Number:
412-469-1147

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
575 COAL VALLEY RD
Provider Second Line Business Practice Location Address:
SOUTH HILLS MEDICAL BUILDING- SUITE 460
Provider Business Practice Location Address City Name:
JEFFERSON HILLS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15025-3730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-469-0600
Provider Business Practice Location Address Fax Number:
412-469-1147
Provider Enumeration Date:
12/13/2012

Additional Information

Authorized Official

Authorized Official Last Name:
TAUBERG
Authorized Official First Name:
STUART
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
412-469-0600

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  MD036728E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1258411002 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 714256 . This is a "HIGHMARK BCBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 060016698 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 102808 . This is a "UPMC FOR LIFE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 61167 . This is a "MEDPLUS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 102808 . This is a "UPMC FOR YOU" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 4244892 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 45-1517044 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0012938830012 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102808 . This is a "UPMC HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 714256S6H . This is a "MEDICARE INDIVIDUAL #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1503537 . This is a "GATEWAY HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 242497 . This is a "COVENTRY HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 45-1517044 . This is a "TRICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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