Provider Demographics
NPI:1962850370
Name:VALLEY PRIMARY CARE GROUP LLC
Entity Type:Organization
Organization Name:VALLEY PRIMARY CARE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:813-541-4831
Mailing Address - Street 1:2121 S MILL AVE STE 223
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-2138
Mailing Address - Country:US
Mailing Address - Phone:480-424-5228
Mailing Address - Fax:480-907-1691
Practice Address - Street 1:2121 S MILL AVE STE 223
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-2138
Practice Address - Country:US
Practice Address - Phone:480-424-5228
Practice Address - Fax:480-907-1691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3397207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty