Healthcare Provider Details

I. General information

NPI: 1710440839
Provider Name (Legal Business Name): 1ST CHOICE CARDIOVASCULAR ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2019
Last Update Date: 04/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 SUPERIOR AVE STE J
MUNSTER IN
46321-4038
US

IV. Provider business mailing address

1040 SIERRA DR STE 400
GREENWOOD IN
46143-7241
US

V. Phone/Fax

Practice location:
  • Phone: 219-865-0893
  • Fax: 219-865-4359
Mailing address:
  • Phone: 317-528-4262
  • Fax: 317-865-8327

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

VIII. Authorized Official

Name: BRAD JOUBERT
Title or Position: SYSTEM DIRECTOR ABO
Credential:
Phone: 317-528-4291