Basic Information
| Provider Information | |||||||||
| NPI: | 1598849721 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VERDE VALLEY HEART, LLC | ||||||||
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| OtherOrganizationName: | VERDE VALLEY HEART CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 294 W HIGHWAY 89A | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | COTTONWOOD | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863263754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286341331 | ||||||||
| FaxNumber: | 9286343130 | ||||||||
| Practice Location | |||||||||
| Address1: | 294 W HIGHWAY 89A | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | COTTONWOOD | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863263754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286341331 | ||||||||
| FaxNumber: | 9286343130 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | DWYER | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | G. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9286341331 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 31960 | AZ | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | 28611 | AZ | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207RI0011X | 14218 | AZ | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207RI0011X | 15736 | AZ | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 363LA2200X | RN073457 | AZ | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.