=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851610729
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEART RHYTHM SPECIALISTS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2010
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 W THOMAS RD SUITE 980
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85013-4224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-289-6898
-----------------------------------------------------
Fax | 480-289-6897
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 34053
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85067-4053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-289-6898
-----------------------------------------------------
Fax | 480-289-6897
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/OWNER
-----------------------------------------------------
Name | DR. WILBER W SU
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 480-289-6898
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 34004
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------