MEDICARE: SOUTHWEST DESERT CARDIOLOGY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1043075427
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST DESERT CARDIOLOGY PC

Provider Business Mailing Address
First Line	:	PO BOX 5608
Second Line	:
City	:	CAREFREE
State	:	AZ
Zip	:	85377-5608
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	33300 N 32ND AVE STE 201
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85085-8825
Country	:	US
Telephone Number	:	623-879-6000
Fax Number	:

Authorized Official
Title or Position	:	OWENER
Name	:	JOHN SALVATORE RANIOLO
Credential	:
Telephone Number	:	623-879-6000

Provider Enumeration Date	:	02/15/2024
Last Update Date	:	02/15/2024

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