# PHOENIX HEART AMBULATORY SURGERY AND ELECTROPHYSIOLOGY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PHASE Surgery Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760064885
- **Authorized official:** JERRY VAN HORN (CENTER DIRECTOR)
- **Authorized official phone:** (602) 806-0357

## Contact information

- **Practice address:** 5859 W TALAVI BLVD STE 140, GLENDALE, AZ 85306-1871
- **Practice address phone:** (602) 806-0357
- **Practice address fax:** (623) 930-6060
- **Mailing address:** 5859 W TALAVI BLVD STE 140, GLENDALE, AZ 85306-1871
- **Mailing address phone:** (602) 806-0357
- **Mailing address fax:** (623) 930-6060

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | — | NULL | Yes |

## Other

- **Enumeration date:** 04/27/2021
- **Last updated:** 02/06/2023