Provider Demographics
NPI:1306315445
Name:EAST VALLEY HEART RHYTHM CLINIC LLC
Entity type:Organization
Organization Name:EAST VALLEY HEART RHYTHM CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHADI
Authorized Official - Middle Name:
Authorized Official - Last Name:IDRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-319-3334
Mailing Address - Street 1:PO BOX 1749
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85244-1749
Mailing Address - Country:US
Mailing Address - Phone:602-319-3334
Mailing Address - Fax:
Practice Address - Street 1:2680 S VAL VISTA DR STE 187
Practice Address - Street 2:SIUTE 187
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1674
Practice Address - Country:US
Practice Address - Phone:602-319-3334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-19
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty