Avantgarde Cardiovascular Services PC
Organization Active NPI Interventional Cardiology Physician · Youngtown, AZ
NPI 1134835358 · NPPES record last updated Jan 31, 2023
Key facts
- NPI
- 1134835358
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Interventional Cardiology Physician 207RI0011X
- Legal business name
- AVANTGARDE CARDIOVASCULAR SERVICES PC
- Practice address
- 11124 W California Ave
Suite G
Youngtown, AZ 85363-1246 - Phone
- (623) 583-2073
- NPI assigned
- Jan 31, 2023
- Organization subpart
- Yes
- Parent organization (as reported)
- AVANTGARDE CARDIOVASCULAR SERVICES PC
Authorized official
- Name
- Peggy Jeter
- Title
- Office Manager
- Phone
- (623) 583-2073
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230407000620 | AZ | Part B Supplier - Clinic/Group Practice | 8426423377 |
Receives reassigned benefits from 1 practitioner Practice locations: Sun City West, AZ; Sun City, AZ; Glendale, AZ |
National Provider Directory
- Part of
- Avantgarde Cardiovascular Services PC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Interventional Cardiology Physician |
207RI0011X | Yes |
Addresses
Primary practice location
11124 W California Ave
Suite G
Youngtown, AZ 85363-1246
Mailing address
11124 W California Ave
Suite G
Youngtown, AZ 85363-1246
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 097588 | Medicaid | AZ |
Other providers in Youngtown, AZ
- Jacqueline Lyn Ashlock
- Aspire Health, LLC
- Atlantis Anesthesia Associates Az PLLC
- Atlantis Global Research Institute, PLLC.
- Atlantis Medical Specialist Az, PLLC
- Ayodeji Ayoola
- Adriana Del Carmen Bedoya
- R Barnabas Bickerton
- Sao Brima
- Karen L Brozik
All providers in Youngtown, AZ · Interventional Cardiology Physician in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 31, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.