Provider Demographics
NPI:1497851463
Name:VERDE VALLEY HEART CENTER
Entity Type:Organization
Organization Name:VERDE VALLEY HEART CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:PEEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-634-1331
Mailing Address - Street 1:PO BOX 2769
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-2510
Mailing Address - Country:US
Mailing Address - Phone:928-634-1331
Mailing Address - Fax:928-634-3130
Practice Address - Street 1:294 W HIGHWAY 89A
Practice Address - Street 2:107
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-3754
Practice Address - Country:US
Practice Address - Phone:928-634-1331
Practice Address - Fax:928-634-3130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14218174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ270497Medicaid
AZD00101Medicare UPIN
AZ270497Medicaid