Provider Demographics
NPI:1386008506
Name:VALLEY VIEW PHYSICIAN PRACTICES LLC
Entity Type:Organization
Organization Name:VALLEY VIEW PHYSICIAN PRACTICES LLC
Other - Org Name:VALLEY VIEW OB/GYN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AVP, SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:TEAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-920-7000
Mailing Address - Street 1:1520 E HAMMER LN
Mailing Address - Street 2:STE 104
Mailing Address - City:FORT MOHAVE
Mailing Address - State:AZ
Mailing Address - Zip Code:86426-6664
Mailing Address - Country:US
Mailing Address - Phone:928-768-1200
Mailing Address - Fax:928-768-1209
Practice Address - Street 1:1520 E HAMMER LN
Practice Address - Street 2:STE 104
Practice Address - City:FORT MOHAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426-6664
Practice Address - Country:US
Practice Address - Phone:928-768-1200
Practice Address - Fax:928-768-1209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-13
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207V00000X, 207Y00000X
AZ5566208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty