Provider Demographics
NPI:1598849721
Name:VERDE VALLEY HEART, LLC
Entity Type:Organization
Organization Name:VERDE VALLEY HEART, LLC
Other - Org Name:VERDE VALLEY HEART CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:G
Authorized Official - Last Name:DWYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-634-1331
Mailing Address - Street 1:294 W HIGHWAY 89A
Mailing Address - Street 2:SUITE 107
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-3754
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:SUITE 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:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31960207RC0000X
AZ28611207RI0011X
AZ14218207RI0011X
AZ15736207RI0011X
AZRN073457363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Not Answered207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty