Provider Demographics
NPI:1417995366
Name:JANA HEART CENTER PC
Entity Type:Organization
Organization Name:JANA HEART CENTER PC
Other - Org Name:DIPAK K JANA MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DIPAK
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:JANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-978-0154
Mailing Address - Street 1:5620 W THUNDERBIRD RD
Mailing Address - Street 2:STE E-1
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4651
Mailing Address - Country:US
Mailing Address - Phone:602-978-0154
Mailing Address - Fax:602-978-2797
Practice Address - Street 1:5620 W THUNDERBIRD RD
Practice Address - Street 2:STE E-1
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4651
Practice Address - Country:US
Practice Address - Phone:602-978-0154
Practice Address - Fax:602-978-2797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13578207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZWCFKQOtherSUN HEALTH PHYSICIANS
AZ251091Medicaid
AZWCFKQOtherSUN HEALTH PHYSICIANS
AZD37079Medicare UPIN