NPIMap

Organization Active NPI

Mountain Heart Medical Practice PLLC

  • Cardiovascular Disease Physician
  • Flagstaff, AZ
National Provider Identifier
1306009519
Registry record updated Apr 7, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
30420 Issued in AZ
Legal business name
MOUNTAIN HEART MEDICAL PRACTICE PLLC
Practice address
2000 S Thompson St
Flagstaff, AZ 86001-8759
Phone
(928) 226-6400
Fax
(928) 226-6411
NPI assigned
Jul 8, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Suzanne R Duval
Title
Credentialing
Phone
90282266400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RC0000X 30420 AZ Primary

Addresses

Primary practice location

2000 S Thompson St
Flagstaff, AZ 86001-8759

Mailing address

2000 S Thompson St
Flagstaff, AZ 86001-8759
Phone (928) 226-6400

National Provider Directory

National Provider Directory

Locations

1759 E Villa Dr
Cottonwood, AZ 86326
Phone (928) 226-6400

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1215475200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1239062400000",
    "number": "1306009519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 S THOMPSON ST",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860018759",
            "telephone_number": "928-226-6400",
            "fax_number": "928-226-6411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 S THOMPSON ST",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860018759",
            "telephone_number": "928-226-6400",
            "fax_number": "928-226-6411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN HEART MEDICAL PRACTICE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-08",
        "last_updated": "2009-04-07",
        "status": "A",
        "authorized_official_last_name": "DUVAL",
        "authorized_official_first_name": "SUZANNE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "90282266400",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "AZ",
            "license": "30420",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flagstaff, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.