Provider Demographics
NPI:1962741298
Name:ARIZONA CARDIOVASCULAR PERFUSION SERVICE
Entity type:Organization
Organization Name:ARIZONA CARDIOVASCULAR PERFUSION SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANGER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-512-4155
Mailing Address - Street 1:500 W THOMAS RD STE 460
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4219
Mailing Address - Country:US
Mailing Address - Phone:623-512-4155
Mailing Address - Fax:623-512-4152
Practice Address - Street 1:500 W THOMAS RD STE 460
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4219
Practice Address - Country:US
Practice Address - Phone:623-512-4155
Practice Address - Fax:623-512-4152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionistGroup - Single Specialty