Provider Demographics
NPI:1326374190
Name:SOUTHWEST EP CLINIC
Entity Type:Organization
Organization Name:SOUTHWEST EP CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DRORY
Authorized Official - Middle Name:S
Authorized Official - Last Name:TENDLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-309-1515
Mailing Address - Street 1:20930 N TATUM BLVD
Mailing Address - Street 2:SUITE 110, BOX 164
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-4270
Mailing Address - Country:US
Mailing Address - Phone:602-309-1515
Mailing Address - Fax:
Practice Address - Street 1:2730 S VAL VISTA DR
Practice Address - Street 2:BLDG 9, SUITE 152
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1675
Practice Address - Country:US
Practice Address - Phone:602-309-1515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-28
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32962207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z133518Medicare PIN
H02908Medicare UPIN