Provider Demographics
NPI:1417142720
Name:VIP HEALTH CENTER INC
Entity Type:Organization
Organization Name:VIP HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEYVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOOCHEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-560-8440
Mailing Address - Street 1:PO BOX 27255
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-0137
Mailing Address - Country:US
Mailing Address - Phone:480-560-8440
Mailing Address - Fax:877-685-4673
Practice Address - Street 1:7339 E WILLIAMS DR # 27255
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-4985
Practice Address - Country:US
Practice Address - Phone:480-560-8440
Practice Address - Fax:877-685-4673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2008-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ120344Medicare PIN