Healthcare Provider Details

I. General information

NPI: 1043241979
Provider Name (Legal Business Name): NORTH PHOENIX HEART CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 11/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 N 3RD ST SUITE 3010
PHOENIX AZ
85020-2425
US

IV. Provider business mailing address

PO BOX 848511
LOS ANGELES CA
90084-8511
US

V. Phone/Fax

Practice location:
  • Phone: 602-861-1168
  • Fax: 602-861-1763
Mailing address:
  • Phone: 602-861-1168
  • Fax: 602-678-6723

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 Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: LEUEEN M BELANGER
Title or Position: ADMINISTRATOR
Credential:
Phone: 602-861-1168