Provider Demographics
NPI:1518037654
Name:CARDIOLOGISTS OF SCOTTSDALE
Entity Type:Organization
Organization Name:CARDIOLOGISTS OF SCOTTSDALE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-734-6088
Mailing Address - Street 1:3016 E ROBIN LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-8422
Mailing Address - Country:US
Mailing Address - Phone:480-734-6088
Mailing Address - Fax:
Practice Address - Street 1:3016 E ROBIN LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-8422
Practice Address - Country:US
Practice Address - Phone:480-734-6088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31631207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ786163Medicaid
AZAZ0734281OtherBLUE CROSS BLUE SHIELD
AZA02400Medicare UPIN
AZZ113039Medicare PIN