Provider Demographics
NPI:1184777831
Name:SOUTHWEST CARDIOLOGY ASSOCIATES PC
Entity type:Organization
Organization Name:SOUTHWEST CARDIOLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MYRON
Authorized Official - Middle Name:B
Authorized Official - Last Name:LICHT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:602-956-2141
Mailing Address - Street 1:19841 N 27TH AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4003
Mailing Address - Country:US
Mailing Address - Phone:602-956-2141
Mailing Address - Fax:602-956-2752
Practice Address - Street 1:19841 N 27TH AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4003
Practice Address - Country:US
Practice Address - Phone:602-956-2141
Practice Address - Fax:602-956-2752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ24447Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER