MEDICARE: ADVANCE CARDIOVASCULAR IMAGING, INC

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	335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier	HCC5326	FL

General Provider Information

NPI Number	:	1376705913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCE CARDIOVASCULAR IMAGING, INC

Provider Business Mailing Address
First Line	:	10260 SW 56TH ST
Second Line	:	SUITE 102
City	:	MIAMI
State	:	FL
Zip	:	33165-7021
Country	:	US
Telephone Number	:	305-270-7855
Fax Number	:	305-270-7857

Provider Business Practice Location Address
First Line	:	10260 SW 56TH ST
Second Line	:	SUITE 102
City	:	MIAMI
State	:	FL
Zip	:	33165-7021
Country	:	US
Telephone Number	:	305-270-7855
Fax Number	:	305-270-7857

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ALEJANDRO DE VILLIERS
Credential	:	RDCS RVT CNMT
Telephone Number	:	786-287-2236

Provider Enumeration Date	:	06/25/2008
Last Update Date	:	02/28/2014

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