Provider Demographics
NPI:1760604243
Name:ADVANCED CARDIOVASCULAR DEVELOPMENT, LLC
Entity Type:Organization
Organization Name:ADVANCED CARDIOVASCULAR DEVELOPMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PACKER
Authorized Official - Middle Name:W
Authorized Official - Last Name:AMY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-745-0211
Mailing Address - Street 1:2123 EXECUTIVE PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801
Mailing Address - Country:US
Mailing Address - Phone:334-704-0307
Mailing Address - Fax:334-704-0578
Practice Address - Street 1:2123 EXECUTIVE PARK DRIVE
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801
Practice Address - Country:US
Practice Address - Phone:334-704-0307
Practice Address - Fax:334-704-0578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty