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General NPI Number Information
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NPI Number | 1538586037
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Entity Type | Organization
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Legal Business Name | ADVANCED CARDIOVASCULAR CENTER LLC
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Dates
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Enumeration Date | 03/21/2014
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Last Update Date | 03/21/2014
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Provider Practice Location Address
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Address Line | 2335 DOUGHERTY FERRY RD SUITE A
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City | SAINT LOUIS
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State | MO
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Zip | 63122-3313
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Country | US
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Telephone | 314-774-7235
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Fax |
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Provider Business Mailing Address
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Address Line | 12430 TESSON FERRY RD #117
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City | SAINT LOUIS
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State | MO
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Zip | 63128-2702
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Country | US
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Telephone | 314-774-7235
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Fax | 314-729-3960
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | GUS ASSI
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Credential |
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Telephone | 314-774-7235
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | LC1326878
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License Number State | MO
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