Provider Demographics
NPI:1508014648
Name:VALLEY INTERNAL MEDICINE ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:VALLEY INTERNAL MEDICINE ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NAGARAJU
Authorized Official - Middle Name:
Authorized Official - Last Name:VEERAMACHANENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-298-1744
Mailing Address - Street 1:13634 N 93RD AVENUE
Mailing Address - Street 2:200
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381
Mailing Address - Country:US
Mailing Address - Phone:623-298-1744
Mailing Address - Fax:623-298-1738
Practice Address - Street 1:13634 N 93RD AVE
Practice Address - Street 2:STE 200
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381
Practice Address - Country:US
Practice Address - Phone:623-298-1744
Practice Address - Fax:623-298-1738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24392207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ360909Medicaid