Provider Demographics
NPI:1306915509
Name:WEST VALLEY URGENT CARE, L.L.C.
Entity type:Organization
Organization Name:WEST VALLEY URGENT CARE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEEVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PUNIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-334-8670
Mailing Address - Street 1:17218 N 72ND DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8562
Mailing Address - Country:US
Mailing Address - Phone:623-334-8670
Mailing Address - Fax:623-334-8675
Practice Address - Street 1:17218 N 72ND DR
Practice Address - Street 2:SUITE 100
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8562
Practice Address - Country:US
Practice Address - Phone:623-334-8670
Practice Address - Fax:623-334-8675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC3684261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ66972Medicare ID - Type Unspecified