Organization
SOUTHWESTERN CARDIOVASCULAR AND THORACIC SURGEONS LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
R RANDALL GRACE MD (PRESIDENT)
(602) 263-7600
Entity
Organization
Contact information
Practice address
10390 N TATUM BLVD, SUITE 103, PHOENIX, AZ 85028
(602) 263-7600
Mailing address
10390 N TATUM BLVD, SUITE 103, PHOENIX, AZ 85028
(602) 263-7600
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F06781
PHOENIX HEALTH PLAN
AZ
Enumeration date
08/09/2006
Last updated
08/22/2020
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