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  7. NPI Record 1649206301

MARYVALE CARDIOLOGY PC
Complete NPI Record 1649206301
Internal Medicine - Cardiovascular Disease in Phoenix, AZ

NPI Status: Active since June 24, 2006

Contact Information

8410 W THOMAS RD
BLDG 2, SUITE 116
PHOENIX, AZ
ZIP 85037
Phone: (623) 848-3295
Fax: (623) 848-3019

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Second Line Business Mailing Address
  7. Provider Business Mailing Address City Name
  8. Provider Business Mailing Address State Name
  9. Provider Business Mailing Address Postal Code
  10. Provider Business Mailing Address Country Code If outside U S
  11. Provider Business Mailing Address Telephone Number
  12. Provider Business Mailing Address Fax Number
  13. Provider First Line Business Practice Location Address
  14. Provider Second Line Business Practice Location Address
  15. Provider Business Practice Location Address City Name
  16. Provider Business Practice Location Address State Name
  17. Provider Business Practice Location Address Postal Code
  18. Provider Business Practice Location Address Country Code If outside U S
  19. Provider Business Practice Location Address Telephone Number
  20. Provider Business Practice Location Address Fax Number
  21. Provider Enumeration Date
  22. Last Update Date
  23. Authorized Official Last Name
  24. Authorized Official First Name
  25. Authorized Official Middle Name
  26. Authorized Official Title or Position
  27. Authorized Official Telephone Number
  28. Healthcare Provider Taxonomy Code 1
  29. Provider License Number State Code 1
  30. Healthcare Provider Primary Taxonomy Switch 1
  31. Other Provider Identifier 1
  32. Other Provider Identifier Type Code 1
  33. Other Provider Identifier State 1
  34. Other Provider Identifier 2
  35. Other Provider Identifier Type Code 2
  36. Other Provider Identifier State 2
  37. Other Provider Identifier Issuer 2
  38. Is Organization Subpart
  39. Authorized Official Name Prefix Text
  40. Authorized Official Credential Text
  41. Healthcare Provider Taxonomy Group 1

Complete NPI Dataset

This page represents the complete record for NPI 1649206301. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1649206301
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address: 8410 W THOMAS RD
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider Second Line Business Mailing Address: BLDG 2, SUITE 116
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Provider Business Mailing Address City Name: PHOENIX
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Provider Business Mailing Address State Name: AZ
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 850373329
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 6238483295
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 6238483019
The city name in the location address of the provider being identified.
Provider First Line Business Practice Location Address: 8410 W THOMAS RD
The State code in the location of the provider being identified.
Provider Second Line Business Practice Location Address: BLDG 2, SUITE 116
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address City Name: PHOENIX
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: AZ
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 850373329
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 6238483295
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Practice Location Address Fax Number: 6238483019
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider Enumeration Date: 6/24/2006
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Last Update Date: 4/20/2010
The date that a record was last updated or changed.
Authorized Official Last Name: GONZALES
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: DEBBIE
The first name of the authorized official.
Authorized Official Middle Name: ANN
The middle name of the authorized official.
Authorized Official Title or Position: OFFICE MANAGER
The title or position of the authorized official.
Authorized Official Telephone Number: 6238483295
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 207RC0000X
The name prefix or salutation of the provider if the provider is an individual; for example, Mr., Mrs., or Corporal.
Provider License Number State Code 1: AZ
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Healthcare Provider Primary Taxonomy Switch 1: Y
The city name in the mailing address of the provider being identified.
Other Provider Identifier 1: 409313
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 05
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Other Provider Identifier State 1: AZ
Other Provider Identifier 2: Z128037
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 2: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 2: AZ
Other Provider Identifier Issuer 2: PTAN
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Is Organization Subpart: N
The country code in the location address of the provider being identified.
Authorized Official Name Prefix Text: MRS.
The telephone number associated with the location address of the provider being identified.
Authorized Official Credential Text: CMA
Healthcare Provider Taxonomy Group 1: 193400000X SINGLE SPECIALTY GROUP