Provider Demographics
NPI:1295835882
Name:COCHISE HEART CENTER PLLC
Entity Type:Organization
Organization Name:COCHISE HEART CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:520-417-0468
Mailing Address - Street 1:PO BOX 30370
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85751-0370
Mailing Address - Country:US
Mailing Address - Phone:520-722-0777
Mailing Address - Fax:520-290-9713
Practice Address - Street 1:75 COLONIA DE SALUD
Practice Address - Street 2:SUITE 200B
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2487
Practice Address - Country:US
Practice Address - Phone:520-417-0468
Practice Address - Fax:520-459-0526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-23
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ83128Medicare PIN