Provider Demographics
NPI:1558675496
Name:VALLEY MEDICAL MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:VALLEY MEDICAL MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:LINDSAY
Authorized Official - Suffix:
Authorized Official - Credentials:D O
Authorized Official - Phone:928-565-3939
Mailing Address - Street 1:4263 HWY 68 STE C
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86413-8569
Mailing Address - Country:US
Mailing Address - Phone:928-565-3939
Mailing Address - Fax:928-565-5386
Practice Address - Street 1:4263 HWY 68 STE C
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86413-8569
Practice Address - Country:US
Practice Address - Phone:928-565-3939
Practice Address - Fax:928-565-5386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ793207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty