Healthcare Provider Details

I. General information

NPI: 1699548891
Provider Name (Legal Business Name): ADVANCED CARDIOVASCULAR SPECIALISTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2023
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2155 E CONFERENCE DR STE 111
TEMPE AZ
85284-2604
US

IV. Provider business mailing address

2155 E CONFERENCE DR STE 115
TEMPE AZ
85284-2604
US

V. Phone/Fax

Practice location:
  • Phone: 480-889-1205
  • Fax: 480-897-1283
Mailing address:
  • Phone: 480-889-1205
  • Fax: 480-897-1283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. JASON BABCOCK
Title or Position: CEO
Credential: MBA
Phone: 480-889-1205