1497517171 NPI number — PIMA HEART PHYSICIANS, PC

Table of content: (NPI 1497517171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497517171 NPI number — PIMA HEART PHYSICIANS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PIMA HEART PHYSICIANS, PC
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:
1497517171
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
555 E RIVER RD STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85704-5843
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-838-3540
Provider Business Mailing Address Fax Number:
520-325-3526

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4475 S I 19 FRONTAGE RD STE 125
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREEN VALLEY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85614-6336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-838-3540
Provider Business Practice Location Address Fax Number:
520-325-3526
Provider Enumeration Date:
01/29/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RASNAKE
Authorized Official First Name:
CLAUDIA
Authorized Official Middle Name:
MARCELLA
Authorized Official Title or Position:
REGIONAL PRESIDENT
Authorized Official Telephone Number:
520-838-2411

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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