Basic Information
| Provider Information | |||||||||
| NPI: | 1255379541 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEART & VASCULAR CENTER OF ARIZONA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1331 N 7TH ST STE 375 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850062707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6023070070 | ||||||||
| FaxNumber: | 6023070080 | ||||||||
| Practice Location | |||||||||
| Address1: | 1331 N 7TH ST STE 375 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850062707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6023070070 | ||||||||
| FaxNumber: | 6023070080 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 02/07/2017 | ||||||||
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| AuthorizedOfficialLastName: | LAUFER | ||||||||
| AuthorizedOfficialFirstName: | NATHAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6023225057 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207RC0001X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | 207RC0000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 328792 | 05 | AZ | MEDICAID |