Provider Demographics
NPI:1245382407
Name:ADVANCED CARDIOLOGY GROUP, PC
Entity Type:Organization
Organization Name:ADVANCED CARDIOLOGY GROUP, PC
Other - Org Name:ADVANCED CARDIOLOGY GROUP, PC
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:OFA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-974-1245
Mailing Address - Street 1:13188 N 103RD DR
Mailing Address - Street 2:SUITE 309
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3064
Mailing Address - Country:US
Mailing Address - Phone:623-974-1245
Mailing Address - Fax:623-583-3394
Practice Address - Street 1:13188 N 103RD DR
Practice Address - Street 2:SUITE 309
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3064
Practice Address - Country:US
Practice Address - Phone:623-974-1245
Practice Address - Fax:623-583-3394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ07-526207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ75575Medicare ID - Type Unspecified