Provider Demographics
NPI:1588629000
Name:ADVANCED CARDIOVASCULAR INTERPRETATIONS MEDICAL GROUP
Entity Type:Organization
Organization Name:ADVANCED CARDIOVASCULAR INTERPRETATIONS MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:PROF
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIENER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-501-5686
Mailing Address - Street 1:PO BOX 2311
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91313-2311
Mailing Address - Country:US
Mailing Address - Phone:818-178-9500
Mailing Address - Fax:
Practice Address - Street 1:15107 VANOWEN ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-4542
Practice Address - Country:US
Practice Address - Phone:818-782-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALAN SHIENER MD INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-18
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0088312Medicaid
CAHW14815Medicare ID - Type UnspecifiedGROUP ID