MEDICARE: NORTHERN ARIZONA CARDIOVASCULAR SPECIALISTS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician

General Provider Information

NPI Number	:	1063461655
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN ARIZONA CARDIOVASCULAR SPECIALISTS PC

Provider Business Mailing Address
First Line	:	77 W FOREST AVE
Second Line	:	SUITE 302
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86001-1481
Country	:	US
Telephone Number	:	928-214-0470
Fax Number	:	928-214-0477

Provider Business Practice Location Address
First Line	:	77 W FOREST AVE
Second Line	:	SUITE 302
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86001-1481
Country	:	US
Telephone Number	:	928-214-0470
Fax Number	:	928-214-0477

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	DR. KENT D WINKLER
Credential	:	M.D.
Telephone Number	:	928-214-0470

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	11/10/2008

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