Provider Demographics
NPI:1083685200
Name:NORTHERN ARIZONA HEART CENTER
Entity Type:Organization
Organization Name:NORTHERN ARIZONA HEART CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NPI
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-532-1970
Mailing Address - Street 1:PO BOX 1360
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85902-1360
Mailing Address - Country:US
Mailing Address - Phone:928-532-1970
Mailing Address - Fax:928-532-1969
Practice Address - Street 1:5171 CUB LAKE RD
Practice Address - Street 2:SUITE C350
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7888
Practice Address - Country:US
Practice Address - Phone:928-532-1970
Practice Address - Fax:928-532-1969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ61914Medicare PIN