Basic Information
| Provider Information | |||||||||
| NPI: | 1366416919 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED CARDIOVASCULAR SPECIALISTS, LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 755 N. 11TH STREET | ||||||||
| Address2: | SUITE P2200 | ||||||||
| City: | BEAUMONT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 777021501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4098921192 | ||||||||
| FaxNumber: | 4098929164 | ||||||||
| Practice Location | |||||||||
| Address1: | 755 N. 11TH STREET | ||||||||
| Address2: | SUITE P2200 | ||||||||
| City: | BEAUMONT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 777021501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4098921192 | ||||||||
| FaxNumber: | 4098929164 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | FOSTER | ||||||||
| AuthorizedOfficialFirstName: | ANGELA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 4098921192 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | CI8264 | 01 | TX | RAILROAD MEDICARE | OTHER | 080142501 | 05 | TX | MEDICAID |