Provider Demographics
NPI:1104815158
Name:CARDIOVASCULAR ASSOCIATES OF MESA PC
Entity type:Organization
Organization Name:CARDIOVASCULAR ASSOCIATES OF MESA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF REVENUE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:OSBACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-641-5400
Mailing Address - Street 1:6309 E BAYWOOD AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-1726
Mailing Address - Country:US
Mailing Address - Phone:480-641-5400
Mailing Address - Fax:480-218-4353
Practice Address - Street 1:6309 E BAYWOOD AVE STE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1726
Practice Address - Country:US
Practice Address - Phone:480-641-5400
Practice Address - Fax:480-218-4353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZE36733Medicare UPIN
AZF70766Medicare UPIN
AZC50631Medicare UPIN
AZP36121Medicare UPIN
AZQ29343Medicare UPIN
AZQ43573Medicare UPIN
AZZ83454Medicare ID - Type UnspecifiedSPADAFORA, ROBERT
AZG47877Medicare UPIN