Provider Demographics
NPI:1285006957
Name:PVIM
Entity Type:Organization
Organization Name:PVIM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALLYSON
Authorized Official - Middle Name:K
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-695-7392
Mailing Address - Street 1:4494 W PEORIA AVE
Mailing Address - Street 2:SUITE 115A
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-2023
Mailing Address - Country:US
Mailing Address - Phone:623-878-5800
Mailing Address - Fax:623-773-2274
Practice Address - Street 1:4494 W PEORIA AVE
Practice Address - Street 2:SUITE 115A
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-2023
Practice Address - Country:US
Practice Address - Phone:623-878-5800
Practice Address - Fax:623-773-2274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-21
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty