MEDICARE: VALLEY MEDICAL MEDICAL CENTER 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	207Q00000X	Family Medicine Physician	793	AZ

General Provider Information

NPI Number	:	1558675496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY MEDICAL MEDICAL CENTER LLC

Provider Business Mailing Address
First Line	:	4263 HWY 68 STE C
Second Line	:
City	:	GOLDEN VALLEY
State	:	AZ
Zip	:	86413-8569
Country	:	US
Telephone Number	:	928-565-3939
Fax Number	:	928-565-5386

Provider Business Practice Location Address
First Line	:	4263 HWY 68 STE C
Second Line	:
City	:	GOLDEN VALLEY
State	:	AZ
Zip	:	86413-8569
Country	:	US
Telephone Number	:	928-565-3939
Fax Number	:	928-565-5386

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHARLES ROBERT LINDSAY
Credential	:	D O
Telephone Number	:	928-565-3939

Provider Enumeration Date	:	08/03/2010
Last Update Date	:	08/03/2010

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