Provider Demographics
NPI:1063461655
Name:NORTHERN ARIZONA CARDIOVASCULAR SPECIALISTS PC
Entity Type:Organization
Organization Name:NORTHERN ARIZONA CARDIOVASCULAR SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:D
Authorized Official - Last Name:WINKLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-214-0470
Mailing Address - Street 1:77 W FOREST AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1481
Mailing Address - Country:US
Mailing Address - Phone:928-214-0470
Mailing Address - Fax:928-214-0477
Practice Address - Street 1:77 W FOREST AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1481
Practice Address - Country:US
Practice Address - Phone:928-214-0470
Practice Address - Fax:928-214-0477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ72522Medicare PIN