Provider Demographics
NPI:1760064885
Name:PHOENIX HEART AMBULATORY SURGERY AND ELECTROPHYSIOLOGY, LLC
Entity Type:Organization
Organization Name:PHOENIX HEART AMBULATORY SURGERY AND ELECTROPHYSIOLOGY, LLC
Other - Org Name:PHASE SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CENTER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN HORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-806-0357
Mailing Address - Street 1:5859 W TALAVI BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-1871
Mailing Address - Country:US
Mailing Address - Phone:602-806-0357
Mailing Address - Fax:623-930-6060
Practice Address - Street 1:5859 W TALAVI BLVD STE 140
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-1871
Practice Address - Country:US
Practice Address - Phone:602-806-0357
Practice Address - Fax:623-930-6060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-27
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty