MEDICARE: HEART AND MIND LLC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1093577314
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEART AND MIND LLC

Provider Business Mailing Address
First Line	:	2036 N GILBERT RD STE 2-500
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85203-2139
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	560 W BROWN RD STE 3001
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85201-3225
Country	:	US
Telephone Number	:	480-210-7182
Fax Number	:	480-741-8573

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	JONATHAN KIRKHAM
Credential	:
Telephone Number	:	623-205-0456

Provider Enumeration Date	:	01/24/2024
Last Update Date	:	04/14/2026

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Directions to “HEART AND MIND LLC ” Practice Location

Language	Start Address	Practice Location

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