Basic Information
| Provider Information | |||||||||
| NPI: | 1508166190 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTH VALLEY VASCULAR ASSOCIATES INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7030 | ||||||||
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| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932907030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596254118 | ||||||||
| FaxNumber: | 5596256004 | ||||||||
| Practice Location | |||||||||
| Address1: | 820 S. AKERS | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932775121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596254118 | ||||||||
| FaxNumber: | 5596256004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2010 | ||||||||
| LastUpdateDate: | 02/10/2015 | ||||||||
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| AuthorizedOfficialLastName: | CAMPBELL | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5596254118 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
No ID Information.