MEDICARE: VALLE DEL SOL URGENT CARE 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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1902105323
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLE DEL SOL URGENT CARE LLC

Provider Business Mailing Address
First Line	:	4338 W THOMAS RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85031-3878
Country	:	US
Telephone Number	:	623-385-7900
Fax Number	:	623-792-1232

Provider Business Practice Location Address
First Line	:	4338 W THOMAS RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85031-3878
Country	:	US
Telephone Number	:	623-385-7900
Fax Number	:	623-792-1232

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. MARTHA ANN CONRADSON
Credential	:
Telephone Number	:	623-385-7900

Provider Enumeration Date	:	03/24/2011
Last Update Date	:	03/24/2011

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