Healthcare Provider Details

I. General information

NPI: 1366206922
Provider Name (Legal Business Name): NATIONAL CARDIOVASCULAR ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 S YALE ST STE 152
FLAGSTAFF AZ
86001-7337
US

IV. Provider business mailing address

12361 W BOLA DR STE 100
SURPRISE AZ
85378-9021
US

V. Phone/Fax

Practice location:
  • Phone: 602-698-7325
  • Fax: 480-500-8430
Mailing address:
  • Phone: 602-698-7325
  • Fax: 480-500-8430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: LINDSEY PENNER
Title or Position: OFFICE MANAGER
Credential:
Phone: 602-698-7325