Organization
HEART INSTITUTE OF NORTHERN ARIZONA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY GUIDRY (CEO)
(704) 815-7804
Entity
Organization
Contact information
Practice address
1753 AIRWAY AVE, SUITE B, KINGMAN, AZ 86409-3720
(928) 692-6200
(928) 692-9474
Mailing address
10720 SIKES PL, SUITE 300, CHARLOTTE, NC 28277-8141
(704) 815-7789
(888) 401-6931
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
261QS1200X
Sleep Disorder Diagnostic Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
197211
—
AZ
01
—
470000205
RAILROAD MEDICARE
AZ
05
—
930348
—
AZ
Enumeration date
11/10/2005
Last updated
10/06/2009
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