Healthcare Provider Details

I. General information

NPI: 1033600432
Provider Name (Legal Business Name): WVF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12409 W INDIAN SCHOOL RD STE B210
AVONDALE AZ
85392-9505
US

IV. Provider business mailing address

12409 W INDIAN SCHOOL RD STE B210
AVONDALE AZ
85392-9505
US

V. Phone/Fax

Practice location:
  • Phone: 623-935-9920
  • Fax:
Mailing address:
  • Phone: 623-935-9920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: THOMAS MORGAN
Title or Position: OWNER
Credential: DC
Phone: 623-935-9920