Provider Demographics
NPI:1679608095
Name:PHOENIX HEART, PLLC
Entity Type:Organization
Organization Name:PHOENIX HEART, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-298-7777
Mailing Address - Street 1:5859 W TALAVI BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-1870
Mailing Address - Country:US
Mailing Address - Phone:602-298-7777
Mailing Address - Fax:623-930-6060
Practice Address - Street 1:5859 W TALAVI BLVD STE 100
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-1870
Practice Address - Country:US
Practice Address - Phone:602-298-7777
Practice Address - Fax:623-930-6060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ27785OtherMEDICARE PTAN
AZZ212189OtherMEDICARE PTAN
AZ275622Medicaid