Organization
HEART CENTER OF NORTHEASTERN ARIZONA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYNDA LANGE (NPI)
(928) 532-1970
Entity
Organization
Contact information
Practice address
2200 E SHOW LOW LAKE RD, CATH LAB, SHOW LOW, AZ 85901-7881
(928) 532-1970
(928) 532-1969
Mailing address
PO BOX 3179, SHOW LOW, AZ 85902-3179
(928) 532-0600
(928) 532-0550
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
OTC3497
AZ
207RI0011X
Interventional Cardiology Physician
Primary
OTC3497
AZ
291U00000X
Clinical Medical Laboratory
OTC3497
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
848707
—
AZ
Enumeration date
02/01/2006
Last updated
06/11/2009
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