Organization
MOUNTAIN HEART CATH LAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUZANNE R DUVAL (CREDENTIALING)
(928) 226-6400
Entity
Organization
Contact information
Practice address
2000 S THOMPSON ST, FLAGSTAFF, AZ 86001-8759
(928) 226-6400
(928) 226-6411
Mailing address
2000 S THOMPSON ST, FLAGSTAFF, AZ 86001-8759
(928) 226-6400
(928) 226-6411
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
30420
AZ
261QR0404X
Cardiac Rehabilitation Clinic/Center
30420
AZ
Other
Enumeration date
07/02/2008
Last updated
04/07/2009
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