Organization
PHOENIX HEART, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYSA MUNHALL (CREDENTIALING MANAGER)
(602) 298-7777
Entity
Organization
Contact information
Practice address
5859 W TALAVI BLVD STE 100, GLENDALE, AZ 85306-1870
(602) 298-7777
(623) 930-6060
Mailing address
5859 W TALAVI BLVD STE 100, GLENDALE, AZ 85306-1870
(602) 298-7777
(623) 930-6060
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
207RI0011X
Interventional Cardiology Physician
—
—
207UN0901X
Nuclear Cardiology Physician
—
—
363A00000X
Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LG0600X
Gerontology Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
275622
—
AZ
01
—
Z212189
MEDICARE PTAN
AZ
01
—
Z27785
MEDICARE PTAN
AZ
Enumeration date
02/23/2007
Last updated
03/11/2021
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