Provider Demographics
NPI:1295877090
Name:WESTERN CARDIOTHORACIC SURGEONS, PLC
Entity type:Organization
Organization Name:WESTERN CARDIOTHORACIC SURGEONS, PLC
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:602-252-2133
Mailing Address - Street 1:1830 S. ALMA SCHOOL ROAD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210
Mailing Address - Country:US
Mailing Address - Phone:480-248-3000
Mailing Address - Fax:480-248-3050
Practice Address - Street 1:4222 E THOMAS ROAD
Practice Address - Street 2:#245
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018
Practice Address - Country:US
Practice Address - Phone:602-252-2133
Practice Address - Fax:602-258-0123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
65926Medicare ID - Type Unspecified