Healthcare Provider Details

I. General information

NPI: 1295877090
Provider Name (Legal Business Name): WESTERN CARDIOTHORACIC SURGEONS, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 08/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4222 E THOMAS ROAD #245
PHOENIX AZ
85018
US

IV. Provider business mailing address

1830 S. ALMA SCHOOL ROAD SUITE 108
MESA AZ
85210
US

V. Phone/Fax

Practice location:
  • Phone: 602-252-2133
  • Fax: 602-258-0123
Mailing address:
  • Phone: 480-248-3000
  • Fax: 480-248-3050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MACHELLE A SHOOK
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 602-252-2133