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Organization

HEART INSTITUTE OF NORTHERN ARIZONA LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. A PAUL KALANITHI M.D. (MEDICAL DIRECTOR)
(928) 757-4359
Entity
Organization

Contact information

Practice address
1753 AIRWAY AVE, SUITE B, KINGMAN, AZ 86409-3720
(928) 692-6200
(928) 692-9474
Mailing address
1753 AIRWAY AVE, SUITE B, KINGMAN, AZ 86409-3720
(928) 692-6200
(928) 692-9474

Taxonomy

Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
OTC710
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
197211
AZ
01
470000205
RR MEDICARE
AZ
05
930348
AZ
01
P0203870
BLUE CROSS BLUE SHIELD OF
AZ
Enumeration date
04/01/2008
Last updated
04/27/2009
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