Provider Demographics
NPI:1912174590
Name:ADVANCED CARDIAC SPECIALISTS, CHARTERED
Entity Type:Organization
Organization Name:ADVANCED CARDIAC SPECIALISTS, CHARTERED
Other - Org Name:ADVANCED CARDIAC SPECIALISTS OUTPATIENT TREATMENT CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:P
Authorized Official - Last Name:FAZIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-545-1808
Mailing Address - Street 1:PO BOX 63423
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85082-3423
Mailing Address - Country:US
Mailing Address - Phone:480-892-2800
Mailing Address - Fax:480-982-1400
Practice Address - Street 1:515 N MESA DR STE 100
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-5914
Practice Address - Country:US
Practice Address - Phone:480-461-4454
Practice Address - Fax:480-844-6590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical