Provider Demographics
NPI:1891907747
Name:ARIZONA VASCULAR MEDICAL EQUIPMENT INC.
Entity type:Organization
Organization Name:ARIZONA VASCULAR MEDICAL EQUIPMENT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ERNESTINA
Authorized Official - Last Name:GRANILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-854-1900
Mailing Address - Street 1:2600 E SOUTHERN AVE
Mailing Address - Street 2:SUITE F2
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7626
Mailing Address - Country:US
Mailing Address - Phone:480-854-1900
Mailing Address - Fax:480-854-1088
Practice Address - Street 1:5432 E SOUTHERN AVE STE 100
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-2772
Practice Address - Country:US
Practice Address - Phone:480-854-1900
Practice Address - Fax:480-854-1088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ07-631470-B332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0275360OtherAZ BC/BS ID #
AZAZ401480OtherPACIFICARE
AZ82-80095OtherUNITED HEALTHCARE
AZ325036Medicaid
AZAX4016OtherHEALTH NET
AZ241407700OtherDEPT. OF LABOR
AZ0005429096OtherAETNA
AZAZ0275360OtherBLUE CROSS BLUE SHIELD
AZ241407700OtherDEPT. OF LABOR