Healthcare Provider Details

I. General information

NPI: 1932683257
Provider Name (Legal Business Name): ASSOCIATED VALLEY RADIOLOGISTS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2018
Last Update Date: 08/14/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5605 W EUGIE AVE STE 110
GLENDALE AZ
85304-1273
US

IV. Provider business mailing address

PO BOX 74134
LOS ANGELES CA
90074-1734
US

V. Phone/Fax

Practice location:
  • Phone: 888-571-7818
  • Fax:
Mailing address:
  • Phone: 602-521-6252
  • Fax: 623-842-5640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: KAREN VAUGHN
Title or Position: VICE PRESIDENT, PROVIDER ENROLLMENT
Credential:
Phone: 330-309-6984