Healthcare Provider Details

I. General information

NPI: 1952311037
Provider Name (Legal Business Name): SOUTHWESTERN CARDIOVASCULAR AND THORACIC SURGEONS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10390 N TATUM BLVD SUITE 103
PHOENIX AZ
85028
US

IV. Provider business mailing address

10390 N TATUM BLVD SUITE 103
PHOENIX AZ
85028
US

V. Phone/Fax

Practice location:
  • Phone: 602-263-7600
  • Fax:
Mailing address:
  • Phone: 602-263-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: R RANDALL GRACE
Title or Position: PRESIDENT
Credential: MD
Phone: 602-263-7600