Provider Demographics
NPI:1689878241
Name:CEDARS HEART CLINIC, LLC
Entity Type:Organization
Organization Name:CEDARS HEART CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ZIAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ELGHOUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-917-5900
Mailing Address - Street 1:1968 N PEART RD
Mailing Address - Street 2:BUILDING B, SUITE 4
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-2495
Mailing Address - Country:US
Mailing Address - Phone:520-836-6661
Mailing Address - Fax:520-836-6663
Practice Address - Street 1:1968 N PEART RD
Practice Address - Street 2:BUILDING B, SUITE 4
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-2495
Practice Address - Country:US
Practice Address - Phone:520-836-6661
Practice Address - Fax:520-836-6663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29317207RI0011X
261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ569048Medicaid
AZ11056Medicare PIN