MEDICARE: ADVANCED CARDIOLOGY GROUP, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207UN0901X	Nuclear Cardiology Physician	07-526	AZ

General Provider Information

NPI Number	:	1245382407
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED CARDIOLOGY GROUP, PC

Provider Business Mailing Address
First Line	:	13188 N 103RD DR
Second Line	:	SUITE 309
City	:	SUN CITY
State	:	AZ
Zip	:	85351-3064
Country	:	US
Telephone Number	:	623-974-1245
Fax Number	:	623-583-3394

Provider Business Practice Location Address
First Line	:	13188 N 103RD DR
Second Line	:	SUITE 309
City	:	SUN CITY
State	:	AZ
Zip	:	85351-3064
Country	:	US
Telephone Number	:	623-974-1245
Fax Number	:	623-583-3394

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. OFA M. WEAVER
Credential	:
Telephone Number	:	623-974-1245

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	11/30/2007

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