Provider Demographics
NPI:1598749269
Name:ARIZINA HEART HOSPITAL, LLC
Entity Type:Organization
Organization Name:ARIZINA HEART HOSPITAL, LLC
Other - Org Name:ARIZONA HEART HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, BUSINESS OFFICE OPERATION
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:FENTEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-702-7500
Mailing Address - Street 1:1930 E THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7711
Mailing Address - Country:US
Mailing Address - Phone:602-532-1000
Mailing Address - Fax:480-682-2540
Practice Address - Street 1:1930 EAST THOMAS ROAD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7711
Practice Address - Country:US
Practice Address - Phone:602-532-1000
Practice Address - Fax:602-532-2000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH 1832282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ432138Medicaid
FL9135481 00Medicaid
030102Medicare Oscar/Certification