=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417995366
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JANA HEART CENTER PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2006
-----------------------------------------------------
Last Update Date | 02/06/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5620 W THUNDERBIRD RD STE E-1
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85306-4651
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-978-0154
-----------------------------------------------------
Fax | 602-978-2797
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5620 W THUNDERBIRD RD STE E-1
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85306-4651
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-978-0154
-----------------------------------------------------
Fax | 602-978-2797
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. DIPAK KUMAR JANA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 602-978-0154
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 13578
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------