Provider Demographics
NPI:1770563017
Name:CARONDELET HEART & VASCULAR INSTITUTE
Entity type:Organization
Organization Name:CARONDELET HEART & VASCULAR INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ODETTE
Authorized Official - Middle Name:C
Authorized Official - Last Name:BOLANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-696-2328
Mailing Address - Street 1:2202 N FORBES BLVD
Mailing Address - Street 2:ATTN:FINANCE MELINDA BLANDEBURGO
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-1412
Mailing Address - Country:US
Mailing Address - Phone:520-872-7722
Mailing Address - Fax:
Practice Address - Street 1:4888 N STONE AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-5749
Practice Address - Country:US
Practice Address - Phone:520-696-2302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-20
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH-1554282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ403775Medicaid
030100Medicare Oscar/Certification