Provider Demographics
| NPI: | 1144482886 |
|---|---|
| Name: | AHI CARDIOVASCULAR SURGEONS LTD |
| Entity type: | Organization |
| Organization Name: | AHI CARDIOVASCULAR SURGEONS LTD |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | MEDICAL DIRECTOR |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | EDWARD |
| Authorized Official - Middle Name: | B |
| Authorized Official - Last Name: | DIETHRICH |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | MD |
| Authorized Official - Phone: | 602-266-2200 |
| Mailing Address - Street 1: | PO BOX 52596 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | PHOENIX |
| Mailing Address - State: | AZ |
| Mailing Address - Zip Code: | 85072-2596 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 602-266-2200 |
| Mailing Address - Fax: | 602-240-6177 |
| Practice Address - Street 1: | 2632 N 20TH ST |
| Practice Address - Street 2: | |
| Practice Address - City: | PHOENIX |
| Practice Address - State: | AZ |
| Practice Address - Zip Code: | 85006-1339 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 602-266-2200 |
| Practice Address - Fax: | 602-240-6177 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | ARIZONA HEART INSTITUTE LTD |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2008-06-25 |
| Last Update Date: | 2018-06-21 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Multi-Specialty | |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 2086S0129X | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | Group - Multi-Specialty |
| No | 2085R0204X | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | Group - Multi-Specialty |
| No | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies | Group - Multi-Specialty | |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
| No | 363LA2200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | Group - Multi-Specialty |
| No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363AS0400X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | Group - Multi-Specialty |
| No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
| No | 207RC0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | Group - Multi-Specialty |
| No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
| No | 207RI0011X | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| AZ | ========= | Other | TAX-ID |
