Provider Demographics
NPI:1275785156
Name:HEART CARE CENTER PC
Entity Type:Organization
Organization Name:HEART CARE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAHENDER
Authorized Official - Middle Name:K
Authorized Official - Last Name:GABA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-704-5570
Mailing Address - Street 1:2020 SILVER CREEK RD
Mailing Address - Street 2:SUITE 102 C
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-8476
Mailing Address - Country:US
Mailing Address - Phone:928-704-5570
Mailing Address - Fax:928-704-5572
Practice Address - Street 1:2020 SILVER CREEK RD
Practice Address - Street 2:SUITE 102 C
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-8476
Practice Address - Country:US
Practice Address - Phone:928-704-5570
Practice Address - Fax:928-704-5572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36851207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty