Provider Demographics
NPI:1003232208
Name:VALLEY VIEW PHYSICIAN PRACTICES LLC
Entity Type:Organization
Organization Name:VALLEY VIEW PHYSICIAN PRACTICES LLC
Other - Org Name:VASCULAR INSTITUTE OF ARIZONA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESS
Authorized Official - Middle Name:
Authorized Official - Last Name:JUDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-920-7000
Mailing Address - Street 1:5300 HWY 95
Mailing Address - Street 2:SUITE H
Mailing Address - City:FORT MOHAVE
Mailing Address - State:AZ
Mailing Address - Zip Code:86426-9251
Mailing Address - Country:US
Mailing Address - Phone:928-770-4984
Mailing Address - Fax:928-770-4987
Practice Address - Street 1:5300 HWY 95
Practice Address - Street 2:SUITE D
Practice Address - City:FORT MOHAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426-9251
Practice Address - Country:US
Practice Address - Phone:928-770-4984
Practice Address - Fax:928-770-4987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ128746Medicare PIN