=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619957529
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VALLEY VIEW ANESTHESIA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2006
-----------------------------------------------------
Last Update Date | 01/29/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 545 VALLEY VIEW DR
-----------------------------------------------------
City | MOLINE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61265-6138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 309-762-5560
-----------------------------------------------------
Fax | 309-762-7351
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 545 VALLEY VIEW DR
-----------------------------------------------------
City | MOLINE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61265-6138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 309-762-5560
-----------------------------------------------------
Fax | 309-762-7351
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. ARVIND MOVVA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 309-762-5560
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------