Provider Demographics
NPI:1669739439
Name:ADVANCED CARDIOLOGY CENTER LLC
Entity type:Organization
Organization Name:ADVANCED CARDIOLOGY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:NITIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-250-4647
Mailing Address - Street 1:1113 E NORTHERN AVE
Mailing Address - Street 2:STE C
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526-3035
Mailing Address - Country:US
Mailing Address - Phone:337-250-4647
Mailing Address - Fax:337-205-7979
Practice Address - Street 1:1113 E NORTHERN AVE
Practice Address - Street 2:STE C
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-3035
Practice Address - Country:US
Practice Address - Phone:337-250-4647
Practice Address - Fax:337-205-7979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty