Provider Demographics
NPI:1932264314
Name:CHEST & CARDIOVASCULAR SURGERY LTD.
Entity Type:Organization
Organization Name:CHEST & CARDIOVASCULAR SURGERY LTD.
Other - Org Name:THORACIC AND VASCULAR SURGERY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:C
Authorized Official - Last Name:SCAPPATURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-258-0491
Mailing Address - Street 1:515 W BUCKEYE RD
Mailing Address - Street 2:SUITE # 205
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85003-2647
Mailing Address - Country:US
Mailing Address - Phone:602-258-0491
Mailing Address - Fax:602-258-0717
Practice Address - Street 1:515 W BUCKEYE RD
Practice Address - Street 2:SUITE # 205
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85003-2647
Practice Address - Country:US
Practice Address - Phone:602-258-0491
Practice Address - Fax:602-258-0717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ237025Medicaid
AZZ0000BGCWKMedicare ID - Type Unspecified
AZD00263Medicare UPIN