Provider Demographics
NPI:1588718910
Name:ADVANCED CARDIOVASCULAR CONSULTANTS,SC
Entity type:Organization
Organization Name:ADVANCED CARDIOVASCULAR CONSULTANTS,SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:LABROO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-788-7522
Mailing Address - Street 1:2200 52ND AVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6363
Mailing Address - Country:US
Mailing Address - Phone:309-788-7522
Mailing Address - Fax:309-788-7562
Practice Address - Street 1:2200 52ND AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6363
Practice Address - Country:US
Practice Address - Phone:309-788-7522
Practice Address - Fax:309-788-7562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36084756174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL047388OtherHEALTH ALLIANCE
IL036084756Medicaid
IL08132070OtherBCBC OF IL PROV#
IA98576OtherBCBS OF IA
IA0283911Medicaid
ILK11762Medicare PIN
IL036084756Medicaid
IA98576OtherBCBS OF IA
IA0283911Medicaid
IL3719511Medicare PIN
IL047388OtherHEALTH ALLIANCE
IA6163923Medicare PIN