Basic Information
| Provider Information | |||||||||
| NPI: | 1063781409 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AFFILIATED HEART SURGEONS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10930 N TATUM BLVD STE 103 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850286069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022637600 | ||||||||
| FaxNumber: | 6022120365 | ||||||||
| Practice Location | |||||||||
| Address1: | 10930 N TATUM BLVD STE 103 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850286069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022637600 | ||||||||
| FaxNumber: | 6022120365 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2011 | ||||||||
| LastUpdateDate: | 12/14/2011 | ||||||||
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| AuthorizedOfficialLastName: | CASKEY | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 6022637600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 15497 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.