Provider Demographics
NPI:1043686207
Name:PEDIATRIC CARDIAC CARE OF ARIZONA
Entity Type:Organization
Organization Name:PEDIATRIC CARDIAC CARE OF ARIZONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:STOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-510-8081
Mailing Address - Street 1:7505 S MCCLINTOCK DR
Mailing Address - Street 2:STE 103
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-5042
Mailing Address - Country:US
Mailing Address - Phone:480-755-1000
Mailing Address - Fax:
Practice Address - Street 1:7505 S MCCLINTOCK DR
Practice Address - Street 2:STE 103
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-5042
Practice Address - Country:US
Practice Address - Phone:480-755-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-11
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25426174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty