Provider Demographics
NPI:1942443742
Name:SOUTHWEST HEART PC
Entity Type:Organization
Organization Name:SOUTHWEST HEART PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFCE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SLUDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-290-5353
Mailing Address - Street 1:6567 E CARONDELET DR
Mailing Address - Street 2:SUITE 225
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-6152
Mailing Address - Country:US
Mailing Address - Phone:520-886-3432
Mailing Address - Fax:520-886-0169
Practice Address - Street 1:6367 E TANQUE VERDE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3829
Practice Address - Country:US
Practice Address - Phone:520-886-3432
Practice Address - Fax:850-886-0169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-09
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1147990174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ64188OtherMEDICARE PTAN
AZ=========OtherTAX ID#