Provider Demographics
NPI:1558654517
Name:WEST VALLEY PHYSICIAN GROUP LLC
Entity Type:Organization
Organization Name:WEST VALLEY PHYSICIAN GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:623-547-5385
Mailing Address - Street 1:5115 N DYSART RD
Mailing Address - Street 2:SUITE 202 #611
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-3032
Mailing Address - Country:US
Mailing Address - Phone:623-547-5385
Mailing Address - Fax:623-547-5386
Practice Address - Street 1:7710 W LOWER BUCKEYE RD
Practice Address - Street 2:SUITE 115
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85043-3439
Practice Address - Country:US
Practice Address - Phone:623-776-2225
Practice Address - Fax:623-776-2299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-24
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty