Provider Demographics
NPI:1235132838
Name:HEART CARE OF SOUTHERN ARIZONA, PC
Entity type:Organization
Organization Name:HEART CARE OF SOUTHERN ARIZONA, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TEDD
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDFINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:520-797-8550
Mailing Address - Street 1:6080 N LA CHOLLA BLVD # 200
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-3533
Mailing Address - Country:US
Mailing Address - Phone:520-797-8550
Mailing Address - Fax:520-797-6986
Practice Address - Street 1:6080 N LA CHOLLA BLVD # 200
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3533
Practice Address - Country:US
Practice Address - Phone:520-797-8550
Practice Address - Fax:520-797-6986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0898214-5207RC0000X, 207RC0001X, 207RP1001X, 207RS0012X, 363A00000X
AZ0868214-5207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ106783Medicaid
AZ106783Medicaid
AZZ61491Medicare PIN