MEDICARE: NORTHERN ARIZONA HEART CENTER

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	207RI0011X	Interventional Cardiology Physician

General Provider Information

NPI Number	:	1083685200
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN ARIZONA HEART CENTER

Provider Business Mailing Address
First Line	:	PO BOX 1360
Second Line	:
City	:	SHOW LOW
State	:	AZ
Zip	:	85902-1360
Country	:	US
Telephone Number	:	928-532-1970
Fax Number	:	928-532-1969

Provider Business Practice Location Address
First Line	:	5171 CUB LAKE RD
Second Line	:	SUITE C350
City	:	SHOW LOW
State	:	AZ
Zip	:	85901-7888
Country	:	US
Telephone Number	:	928-532-1970
Fax Number	:	928-532-1969

Authorized Official
Title or Position	:	NPI
Name	:	LYNDA LANGE
Credential	:
Telephone Number	:	928-532-1970

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	03/05/2008

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Directions to “NORTHERN ARIZONA HEART CENTER ” Practice Location

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