Provider Demographics
NPI:1649463506
Name:RED SEA HEART CENTER PLC
Entity type:Organization
Organization Name:RED SEA HEART CENTER PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HABTEAB
Authorized Official - Middle Name:BETSUAMLAC
Authorized Official - Last Name:FESEHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-344-9300
Mailing Address - Street 1:610 W CATALINA DR
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8011
Mailing Address - Country:US
Mailing Address - Phone:928-344-9300
Mailing Address - Fax:928-344-9304
Practice Address - Street 1:610 W CATALINA DR
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8011
Practice Address - Country:US
Practice Address - Phone:928-344-9300
Practice Address - Fax:928-344-9304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37118207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ232052Medicaid