Provider Demographics
NPI:1629270160
Name:EAST VALLEY FAMILY PHYSICIANS PLC
Entity Type:Organization
Organization Name:EAST VALLEY FAMILY PHYSICIANS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:WALEND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-899-2900
Mailing Address - Street 1:1455 W CHANDLER BLVD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6177
Mailing Address - Country:US
Mailing Address - Phone:480-899-2900
Mailing Address - Fax:480-786-6309
Practice Address - Street 1:1455 W CHANDLER BLVD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6177
Practice Address - Country:US
Practice Address - Phone:480-899-2900
Practice Address - Fax:480-786-6309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22891174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZWDCBGMedicare ID - Type UnspecifiedEAST VALLEY FAMILY PHYSCI