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NPI Code Detail

MEDICARE: WEST VALLEY OTC LLC

MEDICARE: WEST VALLEY OTC 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
1261QM1300XMulti-Specialty Clinic/Center

General Provider Information

NPI Number : 1447799796
Entity Type Code : Organization
Provider Name (Legal Business Name) : WEST VALLEY OTC LLC
Provider Business Mailing Address
First Line : 12409 W INDIAN SCHOOL RD STE B210
Second Line :
City : AVONDALE
State : AZ
Zip : 85392-9505
Country : US
Telephone Number : 623-935-9920
Fax Number :
Provider Business Practice Location Address
First Line : 12409 W INDIAN SCHOOL RD STE B210
Second Line :
City : AVONDALE
State : AZ
Zip : 85392-9505
Country : US
Telephone Number : 623-935-9920
Fax Number :
Authorized Official
Title or Position : SOLE MBR
Name : THOMAS MORGAN
Credential : DC
Telephone Number : 623-935-9920
Provider Enumeration Date : 02/20/2017
Last Update Date : 02/20/2017

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Directions to “WEST VALLEY OTC LLC ” Practice Location

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