=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548660756
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VALLEY VIEW PHYSICIAN PRACTICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2014
-----------------------------------------------------
Last Update Date | 01/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5300 S HIGHWAY 95 SUITE C
-----------------------------------------------------
City | FORT MOHAVE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86426-9251
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-768-2330
-----------------------------------------------------
Fax | 928-768-2360
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5300 S HIGHWAY 95 SUITE C
-----------------------------------------------------
City | FORT MOHAVE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86426-9251
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-768-2330
-----------------------------------------------------
Fax | 928-768-2360
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SECRETARY
-----------------------------------------------------
Name | CHARLOTTE E LAWRENCE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-920-7000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------