Healthcare Provider Details

I. General information

NPI: 1114332988
Provider Name (Legal Business Name): VIG HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 05/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6320 W UNION HILLS DR STE. 1400B
GLENDALE AZ
85308-1096
US

IV. Provider business mailing address

6320 W UNION HILLS DR STE. 1400B
GLENDALE AZ
85308-1096
US

V. Phone/Fax

Practice location:
  • Phone: 602-889-5833
  • Fax:
Mailing address:
  • Phone: 602-889-5833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: STEVE WICKLUND
Title or Position: MANAGER
Credential:
Phone: 602-889-5833