1487990727 NPI number — ADVANCE CARDIOLOGY, PC

Table of content: (NPI 1487990727)

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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