Provider Demographics
NPI:1326217902
Name:SUN VALLEY MEDICAL LLC
Entity type:Organization
Organization Name:SUN VALLEY MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HAMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-399-8939
Mailing Address - Street 1:9299 W OLIVE AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-8379
Mailing Address - Country:US
Mailing Address - Phone:623-399-8939
Mailing Address - Fax:
Practice Address - Street 1:9299 W OLIVE AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-8379
Practice Address - Country:US
Practice Address - Phone:623-399-8939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ6100620001Medicare NSC