Provider Demographics
NPI:1063021269
Name:VALLEY DIRECT PRIMARY CARE, PLLC
Entity Type:Organization
Organization Name:VALLEY DIRECT PRIMARY CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARUN
Authorized Official - Middle Name:
Authorized Official - Last Name:BASSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-562-0130
Mailing Address - Street 1:13970 W WOODBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-1485
Mailing Address - Country:US
Mailing Address - Phone:646-352-2619
Mailing Address - Fax:
Practice Address - Street 1:13970 W WOODBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-1485
Practice Address - Country:US
Practice Address - Phone:646-352-2619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-24
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center