Healthcare Provider Details

I. General information

NPI: 1235132838
Provider Name (Legal Business Name): HEART CARE OF SOUTHERN ARIZONA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6080 N LA CHOLLA BLVD # 200
TUCSON AZ
85741-3533
US

IV. Provider business mailing address

6080 N LA CHOLLA BLVD # 200
TUCSON AZ
85741-3533
US

V. Phone/Fax

Practice location:
  • Phone: 520-797-8550
  • Fax: 520-797-6986
Mailing address:
  • Phone: 520-797-8550
  • Fax: 520-797-6986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0898214-5
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number0898214-5
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number0898214-5
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number0898214-5
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number0868214-5
License Number StateAZ
# 6
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0898214-5
License Number StateAZ

VIII. Authorized Official

Name: TEDD GOLDFINGER
Title or Position: PRESIDENT
Credential: DO
Phone: 520-797-8550