Healthcare Provider Details

I. General information

NPI: 1548510811
Provider Name (Legal Business Name): VALLEY VIEW PHYSICIAN PRACTICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 01/12/2025
Certification Date: 01/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3641 HWAY 95
BULLHEAD CITY AZ
86442-8151
US

IV. Provider business mailing address

3641 HWAY 95
BULLHEAD CITY AZ
86442-8151
US

V. Phone/Fax

Practice location:
  • Phone: 928-763-0450
  • Fax: 928-758-1644
Mailing address:
  • Phone: 928-763-0450
  • Fax: 928-758-1644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHARLOTTE E LAWRENCE
Title or Position: SECRETARY
Credential:
Phone: 615-920-7000