Provider Demographics
NPI:1225313836
Name:VALLEY VIEW PHYSICIAN PRACTICES LLC
Entity Type:Organization
Organization Name:VALLEY VIEW PHYSICIAN PRACTICES LLC
Other - Org Name:SURGICAL INSTITUTE OF ARIZONA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JESS
Authorized Official - Middle Name:N
Authorized Official - Last Name:JUDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-8500
Mailing Address - Street 1:1520 E HAMMER LN STE 104
Mailing Address - Street 2:
Mailing Address - City:FORT MOHAVE
Mailing Address - State:AZ
Mailing Address - Zip Code:86426-6665
Mailing Address - Country:US
Mailing Address - Phone:928-788-2301
Mailing Address - Fax:928-788-2304
Practice Address - Street 1:1520 E HAMMER LN STE 104
Practice Address - Street 2:
Practice Address - City:FORT MOHAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426-6665
Practice Address - Country:US
Practice Address - Phone:928-788-2301
Practice Address - Fax:928-788-2304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty