Provider Demographics
NPI:1043750797
Name:MESA CARDIOVASCULAR RESEARCH CENTER
Entity Type:Organization
Organization Name:MESA CARDIOVASCULAR RESEARCH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HAUGLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-570-1317
Mailing Address - Street 1:4555 E INVERNESS AVE
Mailing Address - Street 2:BLDG 1
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4630
Mailing Address - Country:US
Mailing Address - Phone:480-565-1022
Mailing Address - Fax:480-393-7944
Practice Address - Street 1:4555 E INVERNESS AVE
Practice Address - Street 2:BLDG 1
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4630
Practice Address - Country:US
Practice Address - Phone:480-565-1022
Practice Address - Fax:480-393-7944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-28
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOSC261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical