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General NPI Number Information
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NPI Number | 1245382407
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Entity Type | Organization
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Legal Business Name | ADVANCED CARDIOLOGY GROUP, PC
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 11/30/2007
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Provider Practice Location Address
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Address Line | 13188 N 103RD DR SUITE 309
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City | SUN CITY
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State | AZ
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Zip | 85351-3064
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Country | US
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Telephone | 623-974-1245
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Fax | 623-583-3394
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Provider Business Mailing Address
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Address Line | 13188 N 103RD DR SUITE 309
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City | SUN CITY
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State | AZ
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Zip | 85351-3064
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Country | US
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Telephone | 623-974-1245
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Fax | 623-583-3394
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. OFA M. WEAVER
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Credential |
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Telephone | 623-974-1245
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207UN0901X
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Taxonomy Name | Nuclear Cardiology Physician
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License Number | 07-526
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License Number State | AZ
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