MEDICARE: SOUTHWEST HEART 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	174400000X	Specialist	1147990	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	64188	OTHER	AZ	MEDICARE PTAN

General Provider Information

NPI Number	:	1942443742
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST HEART PC

Provider Business Mailing Address
First Line	:	6567 E CARONDELET DR
Second Line	:	SUITE 225
City	:	TUCSON
State	:	AZ
Zip	:	85710-6152
Country	:	US
Telephone Number	:	520-886-3432
Fax Number	:	520-886-0169

Provider Business Practice Location Address
First Line	:	6367 E TANQUE VERDE RD
Second Line	:	SUITE 100
City	:	TUCSON
State	:	AZ
Zip	:	85715-3829
Country	:	US
Telephone Number	:	520-886-3432
Fax Number	:	850-886-0169

Authorized Official
Title or Position	:	BUSINESS OFFCE SUPERVISOR
Name	:	LAURIE ANN SLUDER
Credential	:
Telephone Number	:	520-290-5353

Provider Enumeration Date	:	04/09/2009
Last Update Date	:	06/21/2018

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Directions to “SOUTHWEST HEART PC ” Practice Location

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