Provider Demographics
NPI:1205135969
Name:EAST VALLEY CRITICAL CARE ASSOCIATES, P.C.
Entity type:Organization
Organization Name:EAST VALLEY CRITICAL CARE ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-717-4751
Mailing Address - Street 1:6750 E BAYWOOD AVE
Mailing Address - Street 2:SUITE 507
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-1749
Mailing Address - Country:US
Mailing Address - Phone:480-835-7111
Mailing Address - Fax:480-218-5706
Practice Address - Street 1:1301 S CRISMON RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-3767
Practice Address - Country:US
Practice Address - Phone:480-358-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service