Provider Demographics
NPI:1003808262
Name:CARDIAC CARE CONSULTANTS, PC
Entity Type:Organization
Organization Name:CARDIAC CARE CONSULTANTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NICCHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-815-2484
Mailing Address - Street 1:13634 N 93RD AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4915
Mailing Address - Country:US
Mailing Address - Phone:623-815-2484
Mailing Address - Fax:623-815-2483
Practice Address - Street 1:13634 N 93RD AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4915
Practice Address - Country:US
Practice Address - Phone:623-815-2484
Practice Address - Fax:623-815-2483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ22804Medicare ID - Type Unspecified