1780009621 NPI number — VALLEY VIEW PHYSICIAN PRACTICES, LLC

Table of content: (NPI 1780009621)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780009621 NPI number — VALLEY VIEW PHYSICIAN PRACTICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY VIEW PHYSICIAN PRACTICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
VALLEY VIEW PHYSICAL MEDICINE AND REHAB
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780009621
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5300 S. HIGHWAY 95
Provider Second Line Business Mailing Address:
STE. D
Provider Business Mailing Address City Name:
FT. MOHAVE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-788-3609
Provider Business Mailing Address Fax Number:
928-788-3607

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5300 S. HIGHWAY 95
Provider Second Line Business Practice Location Address:
STE. D.
Provider Business Practice Location Address City Name:
FT. MOHAVE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-788-3609
Provider Business Practice Location Address Fax Number:
928-788-3607
Provider Enumeration Date:
03/02/2014

Additional Information

Authorized Official

Authorized Official Last Name:
JUDY
Authorized Official First Name:
JESS
Authorized Official Middle Name:
N
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
615-372-8500

Provider Taxonomy Codes

  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X , with the licence number: 33446 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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