1295877090 NPI number — WESTERN CARDIOTHORACIC SURGEONS, PLC

Table of content: (NPI 1295877090)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295877090 NPI number — WESTERN CARDIOTHORACIC SURGEONS, PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTERN CARDIOTHORACIC SURGEONS, PLC
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:
1295877090
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1830 S. ALMA SCHOOL ROAD
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-248-3000
Provider Business Mailing Address Fax Number:
480-248-3050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4222 E THOMAS ROAD
Provider Second Line Business Practice Location Address:
#245
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-252-2133
Provider Business Practice Location Address Fax Number:
602-258-0123
Provider Enumeration Date:
02/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SHOOK
Authorized Official First Name:
MACHELLE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
602-252-2133

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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