LAKESIDE HEART AND VASCULAR CENTER PLLC (NPI# 1801194352) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801194352 |
| Entity Type | Organization |
| Organization Name | LAKESIDE HEART AND VASCULAR CENTER PLLC |
| Practice Address |
1741 Mesquite Ave Suite A100 Lake Havasu City AZ 86403-5695 |
| Mailing Address |
Po Box 3539 Lake Havasu City AZ 86405-3539 |
| Practice Telephone | 9284532727 |
| Practice Fax Number | 9284532828 |
| Mailing Telephone | 9284532727 |
| Mailing Fax Number | 9284532828 |
| Enumeration Date | 2011-03-08 |
| Last Update Date | 2011-07-20 |
| Authorized Official Name | FADI ATASSI (OWNER/MEMBER) |
| Authorized Official Telephone | 9284532727 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
44211 | AZ | Allopathic & Osteopathic Physicians |
| Y | 207RI0011X |
Internal Medicine Specialization: Interventional Cardiology |
44211 | AZ | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | 604490 | 05 | |
| AZ | ARIZONA CORPORATION COMMISSION FILING NUMBER | P-1663566-8 | 01 |
| Street Address |
1741 MESQUITE AVE SUITE A100 |
| City | LAKE HAVASU CITY |
| State | AZ |
| Zip Code | 86403-5695 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619900065 | Pankaj Kulshrestha | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1741 Mesquite Ave, Suite A 200, Lake Havasu City, AZ 86403-5695 | 2006-07-09 |
| 1063811859 | Havasu Cardiac Surgery Pllc | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1741 Mesquite Ave, Ste. A200, Lake Havasu City, AZ 86403-5695 | 2014-08-18 |
| 1316163678 | Larry C Lundin | Dentist | 1741 Mesquite Ave, B 100, Lake Havasu City, AZ 86403 | 2007-04-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104479039 | Liska's Apothecary Shop, Inc. | Assisted Living Facility | 1840 Mesquite Ave., Ste. E, Lake Havasu City, AZ 86403 | 2019-07-19 |
| 1275033227 | Ayad Costy | Pharmacist | 75 North Lake Havasu City, Lake Havasu City, AZ 86403 | 2018-02-16 |
| 1942727250 | Ideal Health Care, L.L.C. | Prosthetic/Orthotic Supplier | 1675 Mesquite Ave Ste A, Lake Havasu City, AZ 86403 | 2017-08-28 |
| 1063965036 | Cerner Health Connections, Inc | Clinic/Center | 89 Civic Center Blvd, Lake Havasu City, AZ 86403 | 2016-07-26 |
| 1447643358 | Lundin Dental PC | Durable Medical Equipment & Medical Supplies | 1741 Mesquite Avenue Ste B 100, Lake Havasu City, AZ 86403 | 2015-03-17 |
| 1912301425 | Arizona Havasu Bdm Pak LLC | Dentist | 1799 North Kiowa Blvd, Unit 109, Lake Havasu, AZ 86403 | 2014-10-13 |
| 1386047850 | Emily E Vona | Nurse Practitioner | 84 Acoma Blvd N Ste 104, Lake Havasu City, AZ 86403 | 2014-09-29 |
| 1750700589 | Thomas Wennergren | Pharmacist | 25 S Lake Havasu Ave, Lake Havasu City, AZ 86403 | 2014-04-09 |
| 1285997460 | Jamie L Lemire | Pharmacist | 1980 Mcculloch Blvd, Lake Havasu City, AZ 86403 | 2012-06-21 |
| 1053694448 | Goodwill of Northern Arizona | Exclusive Provider Organization | 1990 Mcculloch Blvd North, Lake Havasu City, AZ 86403 | 2011-09-22 |
| Find all providers in zip 86403 | ||||
| Taxonomy Code | 207RI0011X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Interventional Cardiology |
| 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. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/ Board Certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. ACGME Accredited Residency Program Requirements: 1 year of training plus a prerequisite of 3 years Internal Medicine, 3 years Cardiovascular Disease for a total of 7 years. ABMS Approved Subspecialty Certificate (Internal Medicine) |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447630538 | Hrmc, LLC | Internal Medicine | 1851 Mesquite Ave, Suite 210, Lake Havasu City, AZ 86403-5677 | 2015-06-03 |
| 1548281629 | Saadeh A Saadeh Md PC | Internal Medicine | 1851 Mesquite Ave, Suite 112, Lake Havasu City, AZ 86403-5677 | 2006-07-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972113546 | Phoenician Cardiac Care LLC | Internal Medicine | 2228 W Northern Ave # D-209, Phoenix, AZ 85021-9369 | 2020-08-07 |
| 1174023584 | Singh Cardiology, Pllc | Internal Medicine | 5170 E Glenn St Ste 130, Tucson, AZ 85712-7300 | 2018-02-13 |
| 1184122434 | Coordinated Health of Az, LLC | Internal Medicine | 2155 W Pinnacle Peak Rd Ste 201c, Phoenix, AZ 85027-1201 | 2018-01-31 |
| 1912405796 | Cardiac Cin of Tucson LLC | Internal Medicine | 5151 E Broadway Blvd Ste 1600a, Tucson, AZ 85711-3777 | 2018-01-26 |
| 1619407442 | Modern Vascular Institute LLC | Internal Medicine | 535 E Mckellips Rd Ste 115, Mesa, AZ 85203 | 2017-06-14 |
| 1578007597 | Rivera Physician Pllc | Internal Medicine | 4345 E Aliso Cyn, Phoenix, AZ 85044-5582 | 2016-12-09 |
| 1841650850 | Cardiac Cath Lab of Phoenix, Lp | Internal Medicine | 1910 E Thomas Rd, Suite 101, Phoenix, AZ 85016-7766 | 2016-03-03 |
| 1770951980 | Evolution Healthcare Management LLC | Internal Medicine | 7615 E Baseline Rd, Suite 101, Mesa, AZ 85209-8520 | 2015-09-03 |
| 1699118240 | Mohammed Tahir Hasoon | Internal Medicine | 9100 N 2nd St Ste 3100, Phoenix, AZ 85020-2446 | 2013-04-14 |
| 1124381637 | Raviinder Mann | Internal Medicine | 3501 N Scottsdale Rd Ste 348, Scottsdale, AZ 85251-5650 | 2012-06-19 |
| Find all providers with the same taxonomy | ||||
| City | LAKE HAVASU CITY |
| Zip Code | 86403 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.