Provider Demographics
NPI:1134562267
Name:COBRE VALLEY HEART INSTITUTE PLLC
Entity type:Organization
Organization Name:COBRE VALLEY HEART INSTITUTE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MIR
Authorized Official - Middle Name:B
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-402-8000
Mailing Address - Street 1:2005 HIGHWAY 60
Mailing Address - Street 2:
Mailing Address - City:GLOBE
Mailing Address - State:AZ
Mailing Address - Zip Code:85501-9601
Mailing Address - Country:US
Mailing Address - Phone:928-402-8000
Mailing Address - Fax:928-402-4279
Practice Address - Street 1:2005 HIGHWAY 60
Practice Address - Street 2:
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501-9601
Practice Address - Country:US
Practice Address - Phone:928-402-8000
Practice Address - Fax:928-402-4279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ47308207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty