MEDICARE: VALLEY MULTI SURGICAL SPECIALISTS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1528925260
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY MULTI SURGICAL SPECIALISTS LLC

Provider Business Mailing Address
First Line	:	4022 E GREENWAY RD STE 11195
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-0445
Country	:	US
Telephone Number	:	602-996-4747
Fax Number	:	602-953-5466

Provider Business Practice Location Address
First Line	:	4022 E GREENWAY RD STE 11195
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-0445
Country	:	US
Telephone Number	:	602-996-4747
Fax Number	:	602-953-5466

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ALICIA J MANGRAM
Credential	:	MD
Telephone Number	:	602-996-4747

Provider Enumeration Date	:	01/06/2026
Last Update Date	:	03/11/2026

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