Provider Demographics
NPI:1558546903
Name:VASCULAR HEART & LUNG ASSOCIATES, PC
Entity Type:Organization
Organization Name:VASCULAR HEART & LUNG ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNERPHYSICAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HANI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHENNIB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-722-7589
Mailing Address - Street 1:10238 E HAMPTON AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-3316
Mailing Address - Country:US
Mailing Address - Phone:480-722-7589
Mailing Address - Fax:480-857-8313
Practice Address - Street 1:10238 E HAMPTON AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-3316
Practice Address - Country:US
Practice Address - Phone:480-722-7589
Practice Address - Fax:480-857-8313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ151193Medicaid