Provider Demographics
NPI:1114965779
Name:VALLEY ARTHRITIS CARE LLC
Entity Type:Organization
Organization Name:VALLEY ARTHRITIS CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:BHALLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-815-2690
Mailing Address - Street 1:13943 N. 91ST AVE
Mailing Address - Street 2:BUILDING I
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381
Mailing Address - Country:US
Mailing Address - Phone:623-815-2690
Mailing Address - Fax:623-815-2689
Practice Address - Street 1:13943 N. 91ST AVE
Practice Address - Street 2:BUILDING I
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381
Practice Address - Country:US
Practice Address - Phone:623-815-2690
Practice Address - Fax:623-815-2689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22399207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z63629Medicare UPIN
AZZ63629Medicare ID - Type UnspecifiedGROUP NUMBER