Provider Demographics
NPI:1184653958
Name:PHOENIX CARDIAC SURGERY PC
Entity Type:Organization
Organization Name:PHOENIX CARDIAC SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:HAO
Authorized Official - Middle Name:K
Authorized Official - Last Name:FANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-253-9168
Mailing Address - Street 1:3131 E CLARENDON AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7069
Mailing Address - Country:US
Mailing Address - Phone:602-253-9168
Mailing Address - Fax:602-251-3126
Practice Address - Street 1:3131 E CLARENDON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7069
Practice Address - Country:US
Practice Address - Phone:602-253-9168
Practice Address - Fax:602-251-3126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ710609Medicaid
Z61977Medicare PIN