Provider Demographics
NPI:1245372580
Name:PHOENIX PERFUSION SERVICES
Entity type:Organization
Organization Name:PHOENIX PERFUSION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:MACHELLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHOOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-248-3070
Mailing Address - Street 1:1830 S ALMA SCHOOL RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3056
Mailing Address - Country:US
Mailing Address - Phone:480-248-3070
Mailing Address - Fax:480-248-3099
Practice Address - Street 1:1830 S ALMA SCHOOL RD
Practice Address - Street 2:SUITE 108
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3056
Practice Address - Country:US
Practice Address - Phone:480-248-3070
Practice Address - Fax:480-248-3099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ126922OtherHEALTHNET
AZAZ0725920OtherBCBS OF AZ