NPIMap

Organization Active NPI

Heart Center of Northeastern Arizona, LLC

  • Interventional Cardiology Physician
  • Show Low, AZ
National Provider Identifier
1619948130
Registry record updated Jun 11, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
OTC3497 Issued in AZ
Legal business name
HEART CENTER OF NORTHEASTERN ARIZONA, LLC
Practice address
2200 E Show Low Lake Rd
Cath Lab
Show Low, AZ 85901-7881
Phone
(928) 532-1970
Fax
(928) 532-1969
NPI assigned
Feb 1, 2006
Last updated
Jun 11, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2009

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

Authorized official

Name
Lynda Lange
Title
Npi
Phone
(928) 532-1970

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X OTC3497 AZ
Cardiovascular Disease Physician 207RC0000X OTC3497 AZ
Interventional Cardiology Physician 207RI0011X OTC3497 AZ Primary

Addresses

Primary practice location

2200 E Show Low Lake Rd
Cath Lab
Show Low, AZ 85901-7881

Mailing address

PO Box 3179
Show Low, AZ 85902-3179
Phone (928) 532-0600

Other identifiers 1

IdentifierTypeStateIssuer
848707MedicaidAZ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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": "1138752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1244678400000",
    "number": "1619948130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3179",
            "city": "SHOW LOW",
            "state": "AZ",
            "postal_code": "859023179",
            "telephone_number": "928-532-0600",
            "fax_number": "928-532-0550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 E SHOW LOW LAKE RD",
            "address_2": "CATH LAB",
            "city": "SHOW LOW",
            "state": "AZ",
            "postal_code": "859017881",
            "telephone_number": "928-532-1970",
            "fax_number": "928-532-1969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEART CENTER OF NORTHEASTERN ARIZONA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-01",
        "last_updated": "2009-06-11",
        "status": "A",
        "authorized_official_last_name": "LANGE",
        "authorized_official_first_name": "LYNDA",
        "authorized_official_title_or_position": "NPI",
        "authorized_official_telephone_number": "928-532-1970"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "AZ",
            "license": "OTC3497",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "AZ",
            "license": "OTC3497",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "AZ",
            "license": "OTC3497",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "848707",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Show Low, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 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.