LAKESIDE HEART AND VASCULAR CENTER PLLC NPI 1801194352

NPI Information

NPI: 1801194352
Provider Name: LAKESIDE HEART AND VASCULAR CENTER PLLC
Classification: Internal Medicine - 207RI0011X
Entity Type: Organization

Specialization: Interventional Cardiology

CLIA Number: 03D2212829

Address:
1741 MESQUITE AVE
SUITE A100
LAKE HAVASU CITY, AZ
ZIP 86403
Phone: (928) 453-2727
Get Directions

LAKESIDE HEART AND VASCULAR CENTER PLLC is an interventional cardiology internal medicine in Lake Havasu City, AZ. The provider is an area of medicine within the subspecialty of cardiology, which uses specialized imaging and other diagnostic techniques to evaluate blood flow and pressure in the coronary arteries and chambers of the heart and uses technical procedures and medications to treat abnormalities that impair the function of the cardiovascular system. LAKESIDE HEART AND VASCULAR CENTER PLLC NPI is 1801194352. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

1741 MESQUITE AVE
SUITE A100
LAKE HAVASU CITY, AZ
ZIP 86403-695
Phone: (928) 453-2727
Fax: (928) 453-2828

The provider's authorized official is Fadi Atassi .
The authorized official title is Owner/member and has the following contact phone number (928) 453-2727.

The CLIA number assigned to this NPI record is 03D2212829 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/8/2011 and was last updated on 7/20/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207RC0000X	Internal Medicine	Cardiovascular Disease	44211	ARIZONA	No
2	207RI0011X	Internal Medicine	Interventional Cardiology	44211	ARIZONA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	Z	MEDICARE PIN	ARIZONA
2	604490	MEDICAID	ARIZONA
3	P-1663566-8	OTHER	ARIZONA	ARIZONA CORPORATION COMMISSION FILING NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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