MEDICARE: THORACIC CARDIOVASCULAR ASSOCIATES LTD

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	174400000X	Specialist	1008	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437266244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THORACIC CARDIOVASCULAR ASSOCIATES LTD

Provider Business Mailing Address
First Line	:	16601 N 40TH ST STE 226
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-3354
Country	:	US
Telephone Number	:	602-264-7741
Fax Number	:	602-277-7402

Provider Business Practice Location Address
First Line	:	16601 N 40TH ST STE 226
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-3354
Country	:	US
Telephone Number	:	602-264-7741
Fax Number	:	602-277-7402

Authorized Official
Title or Position	:	BUSINESS ADMINISTRATOR
Name	:	MR. CLARK BENHAM
Credential	:
Telephone Number	:	602-264-7741

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	11/09/2022

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