Provider Demographics
NPI:1982020137
Name:VIVEK HEALTHCARE ASSOCIATES
Entity Type:Organization
Organization Name:VIVEK HEALTHCARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAISRIDHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:BODDUPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-476-7399
Mailing Address - Street 1:6421 E LE MARCHE AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-2019
Mailing Address - Country:US
Mailing Address - Phone:602-476-7399
Mailing Address - Fax:
Practice Address - Street 1:6421 E LE MARCHE AVE
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-2019
Practice Address - Country:US
Practice Address - Phone:602-476-7399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-12
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ42907282N00000X, 283X00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No282N00000XHospitalsGeneral Acute Care Hospital
No283X00000XHospitalsRehabilitation Hospital