Basic Information
| Provider Information | |||||||||
| NPI: | 1821325747 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ARIZONA CARDIOVASCULAR CLINIC LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 20490 | ||||||||
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| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852770490 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802967646 | ||||||||
| FaxNumber: | 4802967647 | ||||||||
| Practice Location | |||||||||
| Address1: | 10872 E RAINTREE DR | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852551800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809851093 | ||||||||
| FaxNumber: | 4809850468 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2009 | ||||||||
| LastUpdateDate: | 11/13/2009 | ||||||||
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| AuthorizedOfficialLastName: | ALBASHA | ||||||||
| AuthorizedOfficialFirstName: | KHALED | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDIENT | ||||||||
| AuthorizedOfficialTelephone: | 4802967646 | ||||||||
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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 | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.