Provider Demographics
NPI:1568641264
Name:CEDARS CARDIOVASCULAR, P.C.
Entity type:Organization
Organization Name:CEDARS CARDIOVASCULAR, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:RIZK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-443-9580
Mailing Address - Street 1:PO BOX 12015
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86304-2015
Mailing Address - Country:US
Mailing Address - Phone:928-443-9580
Mailing Address - Fax:928-443-9570
Practice Address - Street 1:726 GAIL GARDNER WAY
Practice Address - Street 2:SUITE A
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-2314
Practice Address - Country:US
Practice Address - Phone:928-443-9580
Practice Address - Fax:928-443-9570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23395261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZQ63025Medicare UPIN
AZF58020Medicare UPIN