MEDICARE: WEST VALLEY MOBILITY CENTER, 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1770519274
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST VALLEY MOBILITY CENTER, LLC

Provider Business Mailing Address
First Line	:	5820 W GREENWAY RD
Second Line	:	SUITE 101
City	:	GLENDALE
State	:	AZ
Zip	:	85306-3307
Country	:	US
Telephone Number	:	602-547-1842
Fax Number	:	602-547-8424

Provider Business Practice Location Address
First Line	:	5820 W GREENWAY RD
Second Line	:	SUITE 101
City	:	GLENDALE
State	:	AZ
Zip	:	85306-3307
Country	:	US
Telephone Number	:	602-547-1842
Fax Number	:	602-547-8424

Authorized Official
Title or Position	:	CO-OWNER
Name	:	MR. JOHN W LAYMAN
Credential	:
Telephone Number	:	602-547-1842

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	07/08/2008

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