Provider Demographics
NPI:1346428927
Name:VALLEY NEUROLOGY CLINIC PC
Entity Type:Organization
Organization Name:VALLEY NEUROLOGY CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALIREZA
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMADIEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-391-8222
Mailing Address - Street 1:10752 N 89TH PL STE B214
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6251
Mailing Address - Country:US
Mailing Address - Phone:480-391-8222
Mailing Address - Fax:480-614-8225
Practice Address - Street 1:10752 N 89TH PL STE B214
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6251
Practice Address - Country:US
Practice Address - Phone:480-391-8222
Practice Address - Fax:480-614-8225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30513174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ106844Medicare PIN
AZZWMBFHMedicare UPIN