Provider Demographics
NPI:1326095936
Name:MOUNTAIN WEST CARDIOVASCULAR ASSOCIATES, PC
Entity Type:Organization
Organization Name:MOUNTAIN WEST CARDIOVASCULAR ASSOCIATES, PC
Other - Org Name:HEART CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-571-6100
Mailing Address - Street 1:1160 E 3900 S
Mailing Address - Street 2:STE 2000
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1202
Mailing Address - Country:US
Mailing Address - Phone:901-266-3418
Mailing Address - Fax:801-266-4174
Practice Address - Street 1:1160 E 3900 S
Practice Address - Street 2:SUITE 2000
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1202
Practice Address - Country:US
Practice Address - Phone:801-266-3418
Practice Address - Fax:801-288-4444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000055059Medicare PIN