Healthcare Provider Details

I. General information

NPI: 1275562316
Provider Name (Legal Business Name): ADVANCED CARDIOLOGY AND VASCULAR SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 SALEM PL SUITE 180
FAIRVIEW HEIGHTS IL
62208-1347
US

IV. Provider business mailing address

317 SALEM PL SUITE 180
FAIRVIEW HEIGHTS IL
62208-1347
US

V. Phone/Fax

Practice location:
  • Phone: 618-628-8294
  • Fax:
Mailing address:
  • Phone: 618-628-8294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: RACHEL LYNN COON
Title or Position: OFFICE MANAGER
Credential:
Phone: 618-628-8294