Provider Demographics
NPI:1457679953
Name:ADVANCED HEART GROUP P L
Entity Type:Organization
Organization Name:ADVANCED HEART GROUP P L
Other - Org Name:ADVANCED CARDIOPULMONARY AND MEDICAL CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMSIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-767-9585
Mailing Address - Street 1:PO BOX 731138
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32173-1138
Mailing Address - Country:US
Mailing Address - Phone:386-675-6589
Mailing Address - Fax:386-675-6589
Practice Address - Street 1:26 N BEACH ST
Practice Address - Street 2:SUITE C
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5663
Practice Address - Country:US
Practice Address - Phone:386-675-6589
Practice Address - Fax:386-675-6589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 90030332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies