Provider Demographics
NPI:1598853962
Name:ADVANCED CARDIOLOGY PA
Entity Type:Organization
Organization Name:ADVANCED CARDIOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:LOURIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-773-0244
Mailing Address - Street 1:4900 MANATEE AVE W
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-3859
Mailing Address - Country:US
Mailing Address - Phone:941-746-5200
Mailing Address - Fax:941-746-5266
Practice Address - Street 1:4900 MANATEE AVE W
Practice Address - Street 2:SUITE 201
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-3859
Practice Address - Country:US
Practice Address - Phone:941-746-5200
Practice Address - Fax:941-746-5266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDF6445OtherRR MEDICARE
FL=========OtherTAX ID