Organization
HEART INSTITUTE OF NORTHERN ARIZONA LLC
Active
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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