Basic Information
| Provider Information | |||||||||
| NPI: | 1285655209 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH VALLEY EMERGENCY SPECIALISTS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 SPRING RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | OAK BROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605231804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6304728800 | ||||||||
| FaxNumber: | 6304729502 | ||||||||
| Practice Location | |||||||||
| Address1: | 5555 W THUNDERBIRD RD | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853064622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6025885555 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2006 | ||||||||
| LastUpdateDate: | 04/29/2015 | ||||||||
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| AuthorizedOfficialLastName: | CONTURSI | ||||||||
| AuthorizedOfficialFirstName: | FRANK | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4805136354 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 733114 | 05 | AZ | MEDICAID | AZ0723960 | 01 | AZ | BCBS | OTHER |