Provider Demographics
NPI:1629264148
Name:INTERNAL MEDICINE OF THE VALLEY PLC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE OF THE VALLEY PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:THEODOROU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-277-2361
Mailing Address - Street 1:10585 N TATUM BLVD
Mailing Address - Street 2:D-137
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-1073
Mailing Address - Country:US
Mailing Address - Phone:602-277-2361
Mailing Address - Fax:602-713-9999
Practice Address - Street 1:10585 N TATUM BLVD
Practice Address - Street 2:D-137
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-1073
Practice Address - Country:US
Practice Address - Phone:602-277-2361
Practice Address - Fax:602-713-9999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28436261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ68270Medicare PIN