1336159185 NPI number — NORTHWEST CARDIOVASCULAR AND THORACIC SURGEONS PLLC

Table of content: MR. CHASE ANTHONY EARLING PHARMD (NPI 1770846040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336159185 NPI number — NORTHWEST CARDIOVASCULAR AND THORACIC SURGEONS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWEST CARDIOVASCULAR AND THORACIC SURGEONS 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:
1336159185
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13188 N 103RD DR STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUN CITY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85351-3066
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-875-6001
Provider Business Mailing Address Fax Number:
623-875-8761

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13188 N 103RD DR STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUN CITY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85351-3066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-875-6001
Provider Business Practice Location Address Fax Number:
623-875-8761
Provider Enumeration Date:
08/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VAN DE WATER
Authorized Official First Name:
BONNIE
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
623-875-6001

Provider Taxonomy Codes

  • Taxonomy code: 208G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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