Provider Demographics
NPI:1275562316
Name:ADVANCED CARDIOLOGY AND VASCULAR SERVICES, LLC
Entity Type:Organization
Organization Name:ADVANCED CARDIOLOGY AND VASCULAR SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:COON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-628-8294
Mailing Address - Street 1:317 SALEM PL
Mailing Address - Street 2:SUITE 180
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208-1347
Mailing Address - Country:US
Mailing Address - Phone:618-628-8294
Mailing Address - Fax:
Practice Address - Street 1:317 SALEM PL
Practice Address - Street 2:SUITE 180
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-1347
Practice Address - Country:US
Practice Address - Phone:618-628-8294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Not Answered207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH53547Medicare UPIN