1750571915 NPI number — ADVANCED CARDIOVASCULAR SPECIALISTS

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 1750571915 NPI number — ADVANCED CARDIOVASCULAR SPECIALISTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED CARDIOVASCULAR SPECIALISTS
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:
10/28/2024
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: 7100006010 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000487197 . This is a "ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2864649 . This is a "PASSPORT ADVANTAGE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50016391 . This is a "PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 200879220 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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