Phoenician Cardiac Care LLC
Organization Active NPI Cardiovascular Disease Physician · Phoenix, AZ
NPI 1972113546 · NPPES record last updated Sep 11, 2020
Key facts
- NPI
- 1972113546
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Cardiovascular Disease Physician 207RC0000X
- Legal business name
- PHOENICIAN CARDIAC CARE LLC
- Practice address
- 2228 W Northern Ave # D-209
Phoenix, AZ 85021-9369 - Phone
- (480) 444-7464
- Fax
- (480) 355-1798
- NPI assigned
- Aug 7, 2020
- Organization subpart
- No
Authorized official
- Name
- Mr. Paramvir Tuli
- Title
- Ceo/Owner
- Phone
- (480) 323-0244
Practitioners 14
-
Shiv Bagga, MD
-
Neha Gupta, MD
-
Fady Marmoush, MD
-
Murtaza Mazhar, M.D
-
Robert P Gervais, PA-C
-
Abdul Q Memon, MD
-
Laurie Jenay Burnworth, PA-C
-
Kimberly Cannon, NP
-
Mark Roy Kent, FNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20201027002260 | AZ | Part B Supplier - Clinic/Group Practice | 0749690048 |
Receives reassigned benefits from 10 practitioners Practice locations: Phoenix, AZ; Prescott Valley, AZ; Chandler, AZ; Casa Grande, AZ |
National Provider Directory
Locations
604 W Warner Rd
Ste 201
Chandler, AZ 85225
1343 N Alma School Rd
Ste 295205
Chandler, AZ 85224
2228 W Northern Ave
#D209
Phoenix, AZ 85021
2226 W Northern Ave
Ste D270
Phoenix, AZ 85021
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician |
207RC0000X | Yes | ||
| Interventional Cardiology Physician |
207RI0011X |
Addresses
Primary practice location
2228 W Northern Ave # D-209
Phoenix, AZ 85021-9369
Mailing address
2228 W Northern Ave Ste B210
Phoenix, AZ 85021-9336
Phone (480) 444-7464
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | Phoenix | Health Information Exchange (HIE) |
Other providers in Phoenix, AZ
- Zachary Preston Philpot
- Johnathan Phipps
- Kyle Campbell Phipps
- Mackenzie Mae Phipps
- Phlebotomy to Go, LLC
- Phoenician Eye Specialists
- Phoenician Health Group LLC
- Phoenician Homecare Services LLC
- Phoenician Medical Center Inc
- Phoenician Medical Center Inc
All providers in Phoenix, AZ · Cardiovascular Disease Physician in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 11, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.