Provider Demographics
NPI:1962440602
Name:VALLEY SURGICAL CLINICS, LTD
Entity Type:Organization
Organization Name:VALLEY SURGICAL CLINICS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOEDLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-996-4747
Mailing Address - Street 1:16601 N 40TH ST STE 204
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-3356
Mailing Address - Country:US
Mailing Address - Phone:602-996-4747
Mailing Address - Fax:602-953-5466
Practice Address - Street 1:16601 N 40TH ST STE 204
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-3356
Practice Address - Country:US
Practice Address - Phone:602-996-4747
Practice Address - Fax:602-953-5466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZWCHGXMedicare UPIN