Provider Demographics
NPI:1093810707
Name:SOUTHWEST HEART GROUP LLC
Entity Type:Organization
Organization Name:SOUTHWEST HEART GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFFICE SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SLUDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-886-3432
Mailing Address - Street 1:6567 E CARONDELET DR
Mailing Address - Street 2:SUITE 225
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-6152
Mailing Address - Country:US
Mailing Address - Phone:520-886-3432
Mailing Address - Fax:520-886-0169
Practice Address - Street 1:6567 E CARONDELET DR
Practice Address - Street 2:SUITE 225
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-6152
Practice Address - Country:US
Practice Address - Phone:520-886-3432
Practice Address - Fax:520-886-0169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0147990174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZDG1989OtherRR MEDICARE
AZ115613Medicare PIN
AZ64188Medicare PIN