# ADVANCED HEART CARE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356590178
- **Authorized official:** OMAR ALMOUSALLI MD (OWNER)
- **Authorized official phone:** (618) 222-8900

## Contact information

- **Practice address:** 4600 MEMORIAL DR, W3, BELLEVILLE, IL 62226-5366
- **Practice address phone:** (618) 222-8900
- **Practice address fax:** (618) 222-8950
- **Mailing address:** PO BOX 23140, BELLEVILLE, IL 62223-0140
- **Mailing address phone:** (618) 222-8900
- **Mailing address fax:** (618) 222-8950

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 036097388 | IL | Yes |

## Other

- **Enumeration date:** 09/17/2008
- **Last updated:** 01/08/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0360973885 | — | IL |