Dr. Mario Massullo

LBN: Advanced Cardiovascular Services
Dr. Mario Massullo is an health care organization with primary practice located at 455 W. Court St. Suite 202, Kankakee IL 60441. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Cardiovascular Disease, which is considered as the primary health care specialty. Advanced Cardiovascular Services can be contacted via phone (805) 936-3200, or through Devries, Pat via phone (708) 460-5000.

Contact Information

Primary practice address
455 W. Court St. Suite 202 Kankakee IL 60441
Phone: (805) 936-3200
Fax: (815) 936-3203
Website:
Map and Directions
Authorized official contact:
Name: Devries, Pat
Phone: (708) 460-5000

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Cardiovascular Disease 207RC0000X Illinois

Profile Details

NPI number 1447454657
LBN Legal business name Advanced Cardiovascular Services
DBA Doing business as Dr. Mario Massullo
Authorized official Devries, Pat
Entity Organization
Organization subpart 1 No
Enumeration date Jun 12th, 2007
Last updated Jun 12th, 2008 - about 17 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1447454657 NPPES
Illinois Other 0004632018 BLUE CROSS
Illinois MEDICAID 036082059 BLUE CROSS
Illinois Other P00059541 BLUE CROSS

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