Provider Demographics
NPI:1588924948
Name:VALLEY COLON AND RECTAL SURGICAL SPECIALISTS, PLLC
Entity type:Organization
Organization Name:VALLEY COLON AND RECTAL SURGICAL SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:SCHULTHEIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-257-2736
Mailing Address - Street 1:PO BOX 3125
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85280-3125
Mailing Address - Country:US
Mailing Address - Phone:314-432-2580
Mailing Address - Fax:314-432-0223
Practice Address - Street 1:4153 SOUTH POWER RD
Practice Address - Street 2:SUITE 120
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-3626
Practice Address - Country:US
Practice Address - Phone:480-256-8128
Practice Address - Fax:888-430-0365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-20
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZP-1760941-5208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z154988Medicare PIN