Provider Demographics
NPI:1205264777
Name:JOHN V. BATTERSBY D.O., P.L.L.C.
Entity type:Organization
Organization Name:JOHN V. BATTERSBY D.O., P.L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:BATTERSBY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:602-995-5909
Mailing Address - Street 1:7550 N 19TH AVE
Mailing Address - Street 2:103
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-7980
Mailing Address - Country:US
Mailing Address - Phone:602-995-5909
Mailing Address - Fax:602-864-9233
Practice Address - Street 1:7550 N 19TH AVE
Practice Address - Street 2:103
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-7980
Practice Address - Country:US
Practice Address - Phone:602-995-5909
Practice Address - Fax:602-864-9233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-21
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2209261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ259263Medicaid
AZ259263Medicaid