Provider Demographics
NPI:1033499280
Name:ADVANCED CARDIAC SCREENING, PLLC
Entity Type:Organization
Organization Name:ADVANCED CARDIAC SCREENING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:407-765-0732
Mailing Address - Street 1:1311 MAGNOLIA BAY CT
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-6472
Mailing Address - Country:US
Mailing Address - Phone:407-765-0732
Mailing Address - Fax:407-599-6982
Practice Address - Street 1:13000 AVALON LAKE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-6434
Practice Address - Country:US
Practice Address - Phone:321-235-0970
Practice Address - Fax:321-235-0971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0005851261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1811985112Medicare PIN
FLE60983Medicare UPIN