Provider Demographics
NPI:1942607445
Name:FORTY THIRD MEDICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:FORTY THIRD MEDICAL ASSOCIATES, LLC
Other - Org Name:VANTAGE INTEGRITY MEDICAL, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MCCUE
Authorized Official - Suffix:
Authorized Official - Credentials:RVT, BS
Authorized Official - Phone:719-761-1985
Mailing Address - Street 1:7725 N 43RD AVE
Mailing Address - Street 2:# 111
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-5770
Mailing Address - Country:US
Mailing Address - Phone:623-931-9201
Mailing Address - Fax:623-934-5414
Practice Address - Street 1:7725 N 43RD AVE
Practice Address - Street 2:# 111
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-5770
Practice Address - Country:US
Practice Address - Phone:623-931-9201
Practice Address - Fax:623-934-5414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-26
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE98313246XC2903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XC2903XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularVascular SpecialistGroup - Single Specialty