Basic Information
| Provider Information | |||||||||
| NPI: | 1699962712 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ARIZONA CARDIOVASCULAR SPECIALISTS, PC | ||||||||
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| OtherOrganizationName: | THE HEART CENTER OF SOUTHERN ARIZONA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6206 E PIMA ST | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857127000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5205462420 | ||||||||
| FaxNumber: | 5205462934 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 W CAMINO CASA VERDE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | GREEN VALLEY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856143564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206151023 | ||||||||
| FaxNumber: | 5203201742 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2007 | ||||||||
| LastUpdateDate: | 10/02/2007 | ||||||||
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| AuthorizedOfficialLastName: | PENNOCK | ||||||||
| AuthorizedOfficialFirstName: | GREGORY | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5205462420 | ||||||||
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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 | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.