Provider Demographics
NPI:1013189893
Name:HEART INSTITUTE OF NORTHERN ARIZONA LLC
Entity Type:Organization
Organization Name:HEART INSTITUTE OF NORTHERN ARIZONA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:A
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:KALANITHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-757-4359
Mailing Address - Street 1:1753 AIRWAY AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3720
Mailing Address - Country:US
Mailing Address - Phone:928-692-6200
Mailing Address - Fax:928-692-9474
Practice Address - Street 1:1753 AIRWAY AVE
Practice Address - Street 2:SUITE B
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-3720
Practice Address - Country:US
Practice Address - Phone:928-692-6200
Practice Address - Fax:928-692-9474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC710261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP0203870OtherBLUE CROSS BLUE SHIELD OF
AZ197211Medicaid
AZ470000205OtherRR MEDICARE
AZ930348Medicaid