Provider Demographics
NPI:1508019795
Name:AKDHC - UMC GREEN VALLEY CLINIC
Entity Type:Organization
Organization Name:AKDHC - UMC GREEN VALLEY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPCR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-351-3015
Mailing Address - Street 1:3003 N CENTRAL AVE
Mailing Address - Street 2:STE 400 AKDHC
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-0000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1141 S LA CANADA DRIVE
Practice Address - Street 2:AKDHC - UMC GREEN VALLEY CLINIC
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-0000
Practice Address - Country:US
Practice Address - Phone:520-694-3030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-31
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ112120Medicare PIN
AZ28479Medicare PIN