Provider Demographics
NPI:1922322999
Name:SUN VALLEY COLON & RECTAL SURGERY, LTD.
Entity Type:Organization
Organization Name:SUN VALLEY COLON & RECTAL SURGERY, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PARAVASTHU
Authorized Official - Middle Name:S
Authorized Official - Last Name:RAMANUJAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-933-5866
Mailing Address - Street 1:PO BOX 1543
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85372-1543
Mailing Address - Country:US
Mailing Address - Phone:623-933-5866
Mailing Address - Fax:623-933-5872
Practice Address - Street 1:12361 W BOLA DR
Practice Address - Street 2:#107
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-9021
Practice Address - Country:US
Practice Address - Phone:623-933-5866
Practice Address - Fax:623-933-5872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-19
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAR13460208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty