MEDICARE: VALLEY VIEW PHYSICIAN PRACTICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician
2	207V00000X	Obstetrics & Gynecology Physician
3	2086S0129X	Vascular Surgery Physician	5566	AZ
4	208600000X	Surgery Physician	5566	AZ

General Provider Information

NPI Number	:	1386008506
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY VIEW PHYSICIAN PRACTICES LLC

Provider Business Mailing Address
First Line	:	1520 E HAMMER LN
Second Line	:	STE 104
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86426-6664
Country	:	US
Telephone Number	:	928-768-1200
Fax Number	:	928-768-1209

Provider Business Practice Location Address
First Line	:	1520 E HAMMER LN
Second Line	:	STE 104
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86426-6664
Country	:	US
Telephone Number	:	928-768-1200
Fax Number	:	928-768-1209

Authorized Official
Title or Position	:	SECRETARY
Name	:	CHARLOTTE E LAWRENCE
Credential	:
Telephone Number	:	615-920-7000

Provider Enumeration Date	:	04/13/2016
Last Update Date	:	01/12/2025

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