=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033756937
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED HEART AND VEIN CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2019
-----------------------------------------------------
Last Update Date | 03/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4500 E 9TH AVE STE 540
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80220-3924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-772-8040
-----------------------------------------------------
Fax | 720-805-1551
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 805 E 144TH AVE STE 100
-----------------------------------------------------
City | THORNTON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80023-9210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-772-8040
-----------------------------------------------------
Fax | 720-805-1551
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | QAISAR KHAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 720-772-8040
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RI0011X
-----------------------------------------------------
Taxonomy Name | Interventional Cardiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------