Provider Demographics
NPI:1922381979
Name:VALLEY VIEW PHYSICIAN PRACTICES LLC
Entity Type:Organization
Organization Name:VALLEY VIEW PHYSICIAN PRACTICES LLC
Other - Org Name:VALLEY VIEW MEDICAL CLINIC OF LAUGHLIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JESS
Authorized Official - Middle Name:N
Authorized Official - Last Name:JUDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-8500
Mailing Address - Street 1:1520 E HAMMER LN
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FORT MOHAVE
Mailing Address - State:AZ
Mailing Address - Zip Code:86426-6664
Mailing Address - Country:US
Mailing Address - Phone:702-298-0684
Mailing Address - Fax:702-298-0685
Practice Address - Street 1:3100 NEEDLES HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:LAUGHLIN
Practice Address - State:NV
Practice Address - Zip Code:89029-0814
Practice Address - Country:US
Practice Address - Phone:702-298-0684
Practice Address - Fax:702-298-0685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty