Provider Demographics
NPI:1932404050
Name:ARIZONA HEART PERFUSION, LLC
Entity Type:Organization
Organization Name:ARIZONA HEART PERFUSION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:F
Authorized Official - Last Name:MANDILE
Authorized Official - Suffix:
Authorized Official - Credentials:CCP
Authorized Official - Phone:480-777-0607
Mailing Address - Street 1:PO BOX 27341
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85285-7341
Mailing Address - Country:US
Mailing Address - Phone:480-777-0607
Mailing Address - Fax:480-777-1345
Practice Address - Street 1:5801 S MCCLINTOCK DR
Practice Address - Street 2:110
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-6002
Practice Address - Country:US
Practice Address - Phone:480-777-0607
Practice Address - Fax:480-777-1345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionistGroup - Single Specialty