1649521857 NPI number — CARDIOVASCULAR INSTITUTE II, P.C.

Table of content: (NPI 1649521857)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649521857 NPI number — CARDIOVASCULAR INSTITUTE II, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDIOVASCULAR INSTITUTE II, P.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:
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:
1649521857
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 637
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPOKANE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99210-0637
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-557-7776
Provider Business Mailing Address Fax Number:
509-838-9683

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 W NORA AVE STE 220
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99205-4800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-557-7776
Provider Business Practice Location Address Fax Number:
509-838-9683
Provider Enumeration Date:
09/27/2012

Additional Information

Authorized Official

Authorized Official Last Name:
PAVLIC
Authorized Official First Name:
ROMEO
Authorized Official Middle Name:
ANTON
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
509-557-7776

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  603 203 708 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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