Healthcare Provider Details

I. General information

NPI: 1407801525
Provider Name (Legal Business Name): NORTH VALLEY SURGICAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18699 N 67TH AVE STE 280
GLENDALE AZ
85308-7149
US

IV. Provider business mailing address

18699 N 67TH AVE STE 280
GLENDALE AZ
85308-7149
US

V. Phone/Fax

Practice location:
  • Phone: 602-995-0822
  • Fax: 602-995-0825
Mailing address:
  • Phone: 602-995-0822
  • Fax: 602-995-0825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER HUGGINS
Title or Position: BILLING MANAGER
Credential:
Phone: 602-995-0822