Provider Demographics
NPI:1023249653
Name:ADVANCED HEART AND VASCULAR INSTITUTE
Entity type:Organization
Organization Name:ADVANCED HEART AND VASCULAR INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANSOUR
Authorized Official - Middle Name:H
Authorized Official - Last Name:ASSAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-507-6002
Mailing Address - Street 1:PO BOX 80680
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85060-0680
Mailing Address - Country:US
Mailing Address - Phone:602-507-6002
Mailing Address - Fax:
Practice Address - Street 1:5886 S HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501-9447
Practice Address - Country:US
Practice Address - Phone:602-507-6002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-30
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty