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Organization
PHOENIX HEART AMBULATORY SURGERY AND ELECTROPHYSIOLOGY, LLC
Active
Organization
PHOENIX HEART AMBULATORY SURGERY AND ELECTROPHYSIOLOGY, LLC
Active
Other names
PHASE Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY VAN HORN (CENTER DIRECTOR)
(602) 806-0357
Entity
Organization
Contact information
Practice address
5859 W TALAVI BLVD STE 140, GLENDALE, AZ 85306-1871
(602) 806-0357
(623) 930-6060
Mailing address
5859 W TALAVI BLVD STE 140, GLENDALE, AZ 85306-1871
(602) 806-0357
(623) 930-6060
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
—
NULL
207RC0000X
Cardiovascular Disease Physician
—
—
207RC0001X
Clinical Cardiac Electrophysiology Physician
—
NULL
207RC0001X
Clinical Cardiac Electrophysiology Physician
—
—
207RI0011X
Interventional Cardiology Physician
—
NULL
207RI0011X
Interventional Cardiology Physician
—
—
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
NULL
Other
Enumeration date
04/27/2021
Last updated
02/06/2023
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