Provider Demographics
NPI:1114113636
Name:VALLEY ORTHOPAEDIC GROUP, LTD.
Entity Type:Organization
Organization Name:VALLEY ORTHOPAEDIC GROUP, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BAIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-258-8029
Mailing Address - Street 1:1300 N 12TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2848
Mailing Address - Country:US
Mailing Address - Phone:602-258-8029
Mailing Address - Fax:602-252-9081
Practice Address - Street 1:1300 N 12TH ST
Practice Address - Street 2:SUITE 500
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2848
Practice Address - Country:US
Practice Address - Phone:602-258-8029
Practice Address - Fax:602-252-9081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZWCLBXOtherMEDICARE GROUP NUMBER
AZ204488Medicaid
AZ20WCLBX02Medicare PIN
AZZWCLBXOtherMEDICARE GROUP NUMBER