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General NPI Number Information
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NPI Number | 1972166858
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Entity Type | Organization
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Legal Business Name | RED HEART SURGICAL ASSISTING
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Dates
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Enumeration Date | 04/17/2019
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Last Update Date | 04/17/2019
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Provider Practice Location Address
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Address Line | 43643 W ARIZONA AVE
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City | MARICOPA
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State | AZ
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Zip | 85138-5642
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Country | US
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Telephone | 520-840-7509
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Fax |
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Provider Business Mailing Address
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Address Line | 43643 W ARIZONA AVE
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City | MARICOPA
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State | AZ
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Zip | 85138-5642
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Country | US
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Telephone | 520-840-7509
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CATHEY FREDRICKSON
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Credential | CST, CSFA
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Telephone | 520-840-7509
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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