1013151604 NPI number — APEX HEART CARE, PLLC

Table of content: (NPI 1013151604)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013151604 NPI number — APEX HEART CARE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APEX HEART CARE, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013151604
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8259 N 1ST DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85021-5569
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-300-2793
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3440 W CACTUS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85029-2238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-956-2141
Provider Business Practice Location Address Fax Number:
602-956-2725
Provider Enumeration Date:
04/27/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LICHT
Authorized Official First Name:
MYRON
Authorized Official Middle Name:
B
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
602-300-2793

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 151994 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com