=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477973782
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED CARDIO SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2014
-----------------------------------------------------
Last Update Date | 04/25/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2544 CAMPBELL PL SUITE 275
-----------------------------------------------------
City | CARLSBAD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92009-1752
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-476-1812
-----------------------------------------------------
Fax | 760-476-1836
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2544 CAMPBELL PL SUITE 275
-----------------------------------------------------
City | CARLSBAD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92009-1752
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-476-1812
-----------------------------------------------------
Fax | 760-476-1836
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | C.E.O.
-----------------------------------------------------
Name | TIMOTHY B CADY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 760-579-7201
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 1231672
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------