Healthcare Provider Details

I. General information

NPI: 1194879296
Provider Name (Legal Business Name): ARIZONA HEART INSTITUTE LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2632 N 20TH ST
PHOENIX AZ
85006-1339
US

IV. Provider business mailing address

PO BOX 61773
PHOENIX AZ
85082-1773
US

V. Phone/Fax

Practice location:
  • Phone: 602-266-2200
  • Fax:
Mailing address:
  • Phone: 602-266-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEN WALSH
Title or Position: CFO
Credential:
Phone: 602-266-2200