Provider Demographics
NPI:1376770412
Name:ADVANCED CARDIOVASCULAR INSTITUTE, PLC ANH N. CAMPBELL SOLEMBR
Entity Type:Organization
Organization Name:ADVANCED CARDIOVASCULAR INSTITUTE, PLC ANH N. CAMPBELL SOLEMBR
Other - Org Name:ADVANCED CARDIOVASCULAR INSTITUTE, PLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN/PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANH
Authorized Official - Middle Name:N
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-229-1440
Mailing Address - Street 1:5215 MONTICELLO AVENUE
Mailing Address - Street 2:SUITE A
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188
Mailing Address - Country:US
Mailing Address - Phone:757-229-1440
Mailing Address - Fax:757-253-7590
Practice Address - Street 1:5215 MONTICELLO AVENUE
Practice Address - Street 2:SUITE A
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188
Practice Address - Country:US
Practice Address - Phone:757-229-1440
Practice Address - Fax:757-253-7590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA010105035174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC10960OtherMEDICARE GROUP PTAN
VAC09253OtherMEDICARE PTN
VAF79156Medicare UPIN