Provider Demographics
NPI:1457568842
Name:ARIZONA LUNG SLEEP AND VALLEY FEVER INSTITUTE INC
Entity Type:Organization
Organization Name:ARIZONA LUNG SLEEP AND VALLEY FEVER INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUGROOP
Authorized Official - Middle Name:S
Authorized Official - Last Name:BRAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-242-9830
Mailing Address - Street 1:14961 W BELL RD
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-3200
Mailing Address - Country:US
Mailing Address - Phone:623-561-1456
Mailing Address - Fax:
Practice Address - Street 1:14961 W BELL RD
Practice Address - Street 2:SUITE 175
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3200
Practice Address - Country:US
Practice Address - Phone:623-242-9830
Practice Address - Fax:623-243-6733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34967207RC0200X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ114772Medicaid
AZG73389Medicare UPIN
AZ114772Medicaid