=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649871450
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED HEART AND VEIN SURGERY CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2020
-----------------------------------------------------
Last Update Date | 09/13/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 805 E 144TH AVE STE 200
-----------------------------------------------------
City | THORNTON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80023-9210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-893-5000
-----------------------------------------------------
Fax | 720-792-5001
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 805 E 144TH AVE STE 200
-----------------------------------------------------
City | THORNTON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80023-9210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-893-5000
-----------------------------------------------------
Fax | 720-792-5001
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RAJESH SHARMA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 720-272-2828
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------