Provider Demographics
NPI:1750692372
Name:VALLEY INTEGRATED MEDICINE, LLC
Entity type:Organization
Organization Name:VALLEY INTEGRATED MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:O
Authorized Official - Last Name:BOEHLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-424-4450
Mailing Address - Street 1:6036 N 19TH AVE STE 405
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-2142
Mailing Address - Country:US
Mailing Address - Phone:602-424-4450
Mailing Address - Fax:602-445-7342
Practice Address - Street 1:6036 N 19TH AVE STE 405
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2142
Practice Address - Country:US
Practice Address - Phone:602-424-4450
Practice Address - Fax:602-445-7342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31029208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty