1043329394 NPI number — CARDIOVASCULAR CARE ASSOCIATES S.C.

Table of content: (NPI 1043329394)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043329394 NPI number — CARDIOVASCULAR CARE ASSOCIATES S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDIOVASCULAR CARE ASSOCIATES S.C.
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:
1043329394
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3800 203RD ST
Provider Second Line Business Mailing Address:
SUITE 209
Provider Business Mailing Address City Name:
OLYMPIA FIELDS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60461-1936
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-283-1800
Provider Business Mailing Address Fax Number:
708-283-8607

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3800 203RD ST
Provider Second Line Business Practice Location Address:
SUITE 209
Provider Business Practice Location Address City Name:
OLYMPIA FIELDS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60461-1936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-283-1800
Provider Business Practice Location Address Fax Number:
708-283-8607
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MULAMALLA
Authorized Official First Name:
NARAYAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
708-283-1800

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200194920A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: H3947 . This is a "RAILROD MEDICARE GROUP NU" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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