Healthcare Provider Details

I. General information

NPI: 1144455478
Provider Name (Legal Business Name): VALLEY VIEW PHYSICIAN PRACTICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2009
Last Update Date: 01/12/2025
Certification Date: 01/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 S HIGHWAY 95 SUITE K
FORT MOHAVE AZ
86426-9251
US

IV. Provider business mailing address

5300 S HIGHWAY 95 SUITE K
FORT MOHAVE AZ
86426-9251
US

V. Phone/Fax

Practice location:
  • Phone: 928-768-4499
  • Fax: 928-768-6499
Mailing address:
  • Phone: 928-768-4499
  • Fax: 928-768-6499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

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