1427283092 NPI number — WESTERN ARIZONA CARDIOVASCULAR SURGERY PLLC

Table of content: (NPI 1427283092)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427283092 NPI number — WESTERN ARIZONA CARDIOVASCULAR SURGERY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTERN ARIZONA CARDIOVASCULAR SURGERY 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:
1427283092
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8144 E CACTUS RD
Provider Second Line Business Mailing Address:
SUITE 800
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85260-5266
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-596-8525
Provider Business Mailing Address Fax Number:
490-596-8522

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1851 MESQUITE AVE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
LAKE HAVASU CITY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86403-5677
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-854-0090
Provider Business Practice Location Address Fax Number:
928-453-0671
Provider Enumeration Date:
05/26/2009

Additional Information

Authorized Official

Authorized Official Last Name:
KWON
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
928-854-0090

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X , with the licence number:  32875 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208G00000X , with the licence number: 32875 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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