Provider Demographics
NPI:1033324595
Name:WEST VALLEY COLON AND RECTAL SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:WEST VALLEY COLON AND RECTAL SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HADI
Authorized Official - Middle Name:RAZAVI
Authorized Official - Last Name:NAJAFIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:623-875-7330
Mailing Address - Street 1:10503 WEST THUNDERBIRD BLVD.
Mailing Address - Street 2:SUITE 114
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351
Mailing Address - Country:US
Mailing Address - Phone:623-875-7330
Mailing Address - Fax:
Practice Address - Street 1:10503 W THUNDERBIRD BLVD
Practice Address - Street 2:SUITE 114
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3022
Practice Address - Country:US
Practice Address - Phone:623-875-7330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4626208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ116969Medicare PIN