Provider Demographics
NPI:1437266244
Name:THORACIC CARDIOVASCULAR ASSOCIATES LTD
Entity Type:Organization
Organization Name:THORACIC CARDIOVASCULAR ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BENHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-264-7741
Mailing Address - Street 1:16601 N 40TH ST STE 226
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-3354
Mailing Address - Country:US
Mailing Address - Phone:602-264-7741
Mailing Address - Fax:602-277-7402
Practice Address - Street 1:16601 N 40TH ST STE 226
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-3354
Practice Address - Country:US
Practice Address - Phone:602-264-7741
Practice Address - Fax:602-277-7402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1008174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ22763801Medicaid
AZ22763801Medicaid
AZ22763801Medicaid