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General NPI Number Information
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NPI Number | 1255817847
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Entity Type | Organization
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Legal Business Name | ATLANTIS CARDIAC & VASCULAR CENTER OF SURPRISE, LLC
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Dates
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Enumeration Date | 07/17/2018
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Last Update Date | 07/17/2018
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Provider Practice Location Address
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Address Line | 12361 W BOLA DR
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City | SURPRISE
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State | AZ
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Zip | 85378-9021
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Country | US
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Telephone | 623-815-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 50 E RIO SALADO PKWY
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City | TEMPE
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State | AZ
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Zip | 85281-9102
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Country | US
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Telephone | 480-967-2037
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Fax |
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Authorized Official
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Title or Position | COO
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Name | TIMOTHY COZATT
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Credential |
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Telephone | 480-395-8211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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