Healthcare Provider Details

I. General information

NPI: 1467653048
Provider Name (Legal Business Name): ARIZONA HEART INSTITUTE LTD PRESCOTT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 AINSWORTH DR SUITE A
PRESCOTT AZ
86301-1623
US

IV. Provider business mailing address

PO BOX 61773
PHOENIX AZ
85082-1773
US

V. Phone/Fax

Practice location:
  • Phone: 928-445-6025
  • Fax: 602-240-6177
Mailing address:
  • Phone: 602-687-6701
  • Fax: 602-240-6177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: KEN WALSH
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 602-266-2200