Healthcare Provider Details

I. General information

NPI: 1619957529
Provider Name (Legal Business Name): VALLEY VIEW ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 01/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 VALLEY VIEW DR
MOLINE IL
61265-6138
US

IV. Provider business mailing address

545 VALLEY VIEW DR
MOLINE IL
61265-6138
US

V. Phone/Fax

Practice location:
  • Phone: 309-762-5560
  • Fax: 309-762-7351
Mailing address:
  • Phone: 309-762-5560
  • Fax: 309-762-7351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. ARVIND MOVVA
Title or Position: CEO
Credential: MD
Phone: 309-762-5560