1790172922 NPI number — YUMA VALLEY AMBULATORY PAIN SERVICES INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790172922 NPI number — YUMA VALLEY AMBULATORY PAIN SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YUMA VALLEY AMBULATORY PAIN SERVICES INC
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:
Provider Other Organization Name Type Code:
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:
1790172922
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2270 S RIDGEVIEW DR
Provider Second Line Business Mailing Address:
SUITE 207
Provider Business Mailing Address City Name:
YUMA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85364-8875
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-783-4640
Provider Business Mailing Address Fax Number:
928-329-4886

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2270 S RIDGEVIEW DR
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
YUMA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85364-8875
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-783-4640
Provider Business Practice Location Address Fax Number:
928-329-4886
Provider Enumeration Date:
04/27/2015

Additional Information

Authorized Official

Authorized Official Last Name:
CURRY
Authorized Official First Name:
JEREMY
Authorized Official Middle Name:
S
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
928-783-4640

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  32246 , 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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