Provider Demographics
NPI:1487193371
Name:EAST VALLEY UROLOGY CENTER PLC
Entity Type:Organization
Organization Name:EAST VALLEY UROLOGY CENTER PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RAHUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:MEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-409-5080
Mailing Address - Street 1:6116 E ARBOR AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-6107
Mailing Address - Country:US
Mailing Address - Phone:480-219-1010
Mailing Address - Fax:480-219-1771
Practice Address - Street 1:6116 E ARBOR AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-6107
Practice Address - Country:US
Practice Address - Phone:480-219-1010
Practice Address - Fax:480-219-1771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ45544261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty