MEDICARE: CARONDELET HEART & VASCULAR INSTITUTE

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	282N00000X	General Acute Care Hospital	H-1554	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770563017
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARONDELET HEART & VASCULAR INSTITUTE

Provider Business Mailing Address
First Line	:	2202 N FORBES BLVD
Second Line	:	ATTN:FINANCE MELINDA BLANDEBURGO
City	:	TUCSON
State	:	AZ
Zip	:	85745-1412
Country	:	US
Telephone Number	:	520-872-7722
Fax Number	:

Provider Business Practice Location Address
First Line	:	4888 N STONE AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-5749
Country	:	US
Telephone Number	:	520-696-2302
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ODETTE C BOLANO
Credential	:
Telephone Number	:	520-696-2328

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	10/05/2010

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