1134398571 NPI number — VALLEY CHEST & VASCULAR SURGEONS PLLC

Table of content: (NPI 1134398571)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134398571 NPI number — VALLEY CHEST & VASCULAR SURGEONS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY CHEST & VASCULAR SURGEONS PLLC
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:
1134398571
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29834 N CAVE CREEK RD STE 118-162
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAVE CREEK
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85331-5836
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-633-2247
Provider Business Mailing Address Fax Number:
602-633-2347

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18555 N 79TH AVE
Provider Second Line Business Practice Location Address:
SUITE E105
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85308-8370
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-633-2247
Provider Business Practice Location Address Fax Number:
602-633-2347
Provider Enumeration Date:
02/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
SUNDEEP
Authorized Official Middle Name:
S
Authorized Official Title or Position:
SOLE MEMBER
Authorized Official Telephone Number:
602-633-2247

Provider Taxonomy Codes

  • Taxonomy code: 208G00000X , with the licence number:  31155 , 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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