Provider Demographics
NPI:1356414346
Name:PARADISE VALLEY ALLERGY ASSOC LTD
Entity type:Organization
Organization Name:PARADISE VALLEY ALLERGY ASSOC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:KEIGHTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-991-1930
Mailing Address - Street 1:20940 N TATUM BLVD
Mailing Address - Street 2:STE 205
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-7260
Mailing Address - Country:US
Mailing Address - Phone:480-991-1930
Mailing Address - Fax:480-443-8196
Practice Address - Street 1:20940 N TATUM BLVD
Practice Address - Street 2:STE 205
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-7260
Practice Address - Country:US
Practice Address - Phone:480-991-1930
Practice Address - Fax:480-443-8196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ118562080P0201X, 207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4022160OtherAETNA PPO
AZ0200027OtherUNITED HEATH CARE
AZ1Z2992OtherHEALTHNET
AZ2572627OtherAETNA HMO
AZAZ0027920OtherBCBS
AZ2572627OtherAETNA HMO
AZAZ0027920OtherBCBS