Provider Demographics
NPI:1407801525
Name:NORTH VALLEY SURGICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:NORTH VALLEY SURGICAL ASSOCIATES, PC
Other - Org Name:ARIZONA PREFERRED SURGEONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-995-0822
Mailing Address - Street 1:18699 N 67TH AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-7149
Mailing Address - Country:US
Mailing Address - Phone:602-995-0822
Mailing Address - Fax:602-995-0825
Practice Address - Street 1:18699 N 67TH AVE STE 280
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-7149
Practice Address - Country:US
Practice Address - Phone:602-995-0822
Practice Address - Fax:602-995-0825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ137465Medicaid
AZ137465Medicaid
AZ02WCJCB03Medicare ID - Type Unspecified