Healthcare Provider Details

I. General information

NPI: 1912174590
Provider Name (Legal Business Name): ADVANCED CARDIAC SPECIALISTS, CHARTERED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 05/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 N MESA DR STE 100
MESA AZ
85201-5914
US

IV. Provider business mailing address

PO BOX 63423
PHOENIX AZ
85082-3423
US

V. Phone/Fax

Practice location:
  • Phone: 480-461-4454
  • Fax: 480-844-6590
Mailing address:
  • Phone: 480-892-2800
  • Fax: 480-982-1400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. WILLIAM P FAZIO
Title or Position: CONTROLLER
Credential:
Phone: 480-545-1808