1578595765 NPI number — ADVANCED HEART & LUNG SURGEONS, INC.

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 1578595765 NPI number — ADVANCED HEART & LUNG SURGEONS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED HEART & LUNG SURGEONS, INC.
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:
1578595765
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 E APPLE ST STE 4256
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAYTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45409-2939
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-279-9777
Provider Business Mailing Address Fax Number:
937-279-9332

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 E APPLE ST STE 4256
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-279-9777
Provider Business Practice Location Address Fax Number:
937-279-9332
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WALESKOWSKI
Authorized Official First Name:
PETER
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
937-279-9777

Provider Taxonomy Codes

  • Taxonomy code: 208G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0825110 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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