Provider Demographics
NPI:1750785358
Name:ATRIA HEART PLLC
Entity type:Organization
Organization Name:ATRIA HEART PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MAULIK
Authorized Official - Middle Name:G
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-235-9003
Mailing Address - Street 1:PO BOX 13507
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85267-3507
Mailing Address - Country:US
Mailing Address - Phone:480-718-5072
Mailing Address - Fax:480-718-5074
Practice Address - Street 1:16427 N SCOTTSDALE RD
Practice Address - Street 2:STE. 100
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-8197
Practice Address - Country:US
Practice Address - Phone:480-718-5072
Practice Address - Fax:480-718-5074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-10
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ41574207RI0011X, 207RC0000X
207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ978845Medicaid
AZP19566801OtherPLLC REGISTRATION NUMBER
AZ978845Medicaid