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General NPI Number Information
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NPI Number | 1497851463
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Entity Type | Organization
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Legal Business Name | VERDE VALLEY HEART CENTER
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 294 W HIGHWAY 89A 107
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City | COTTONWOOD
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State | AZ
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Zip | 86326-3754
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Country | US
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Telephone | 928-634-1331
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Fax | 928-634-3130
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Provider Business Mailing Address
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Address Line | PO BOX 2769
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City | COTTONWOOD
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State | AZ
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Zip | 86326-2510
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Country | US
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Telephone | 928-634-1331
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Fax | 928-634-3130
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | MR. BRUCE WILLIAM PEEK
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Credential | M.D.
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Telephone | 928-634-1331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 14218
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License Number State | AZ
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