1447454657 NPI number — ADVANCED CARDIOVASCULAR SERVICES

Table of content: (NPI 1447454657)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447454657 NPI number — ADVANCED CARDIOVASCULAR SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED CARDIOVASCULAR SERVICES
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:
1447454657
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 882
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANKAKEE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60901-0882
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-936-3200
Provider Business Mailing Address Fax Number:
815-936-3203

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
455 W. COURT ST.
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
KANKAKEE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-936-3200
Provider Business Practice Location Address Fax Number:
815-936-3203
Provider Enumeration Date:
06/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DEVRIES
Authorized Official First Name:
PAT
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
708-460-5000

Provider Taxonomy Codes

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

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

  • Identifier: 0004632018 . This is a "BLUE CROSS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036082059 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00059541 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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