Provider Demographics
NPI:1558836270
Name:CARDIAC CATH LAB OF MESA, LLC
Entity type:Organization
Organization Name:CARDIAC CATH LAB OF MESA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SPELLMIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-812-7586
Mailing Address - Street 1:10000 MEMORIAL DR STE 540
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-3425
Mailing Address - Country:US
Mailing Address - Phone:281-889-6883
Mailing Address - Fax:713-335-3378
Practice Address - Street 1:4555 E INVERNESS AVE STE 1
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4630
Practice Address - Country:US
Practice Address - Phone:713-812-7586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty