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General NPI Number Information
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NPI Number | 1043301385
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Entity Type | Organization
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Legal Business Name | CARDIAC CARE CENTER LLC
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 230 N BROAD ST MS 225 2ND FL. BOBST BLDG.
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City | PHILADELPHIA
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State | PA
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Zip | 19102-1121
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Country | US
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Telephone | 215-762-7350
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Fax |
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Provider Business Mailing Address
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Address Line | 230 N BROAD ST MS 225 2ND FL. BOBST BLDG.
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City | PHILADELPHIA
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State | PA
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Zip | 19102-1121
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Country | US
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Telephone | 215-762-7350
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Fax |
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Authorized Official
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Title or Position | MEDICAL LIAISON
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Name | DR. MARK F. VICTOR
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Credential | MD
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Telephone | 215-762-7776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State | PA
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