Basic Information
Provider Information | |||||||||
NPI: | 1528248515 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | VALLEY OXIMETRY INCORPORATED | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | VALLEY SLEEP CENTER | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 30388 | ||||||||
Address2: |   | ||||||||
City: | MESA | ||||||||
State: | AZ | ||||||||
PostalCode: | 852750388 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4808303900 | ||||||||
FaxNumber: | 4808303901 | ||||||||
Practice Location | |||||||||
Address1: | 4141 N 32ND ST | ||||||||
Address2: | SUITE 104 | ||||||||
City: | PHOENIX | ||||||||
State: | AZ | ||||||||
PostalCode: | 850184775 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4808303900 | ||||||||
FaxNumber: | 4808303901 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/07/2007 | ||||||||
LastUpdateDate: | 02/24/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | LEADLEY | ||||||||
AuthorizedOfficialFirstName: | LAURI | ||||||||
AuthorizedOfficialMiddleName: | L | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT & CEO | ||||||||
AuthorizedOfficialTelephone: | 4808303900 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MRS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | RCP, RPSGT | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QS1200X | OTC 3943 | AZ | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic |
ID Information
ID | Type | State | Issuer | Description | 1Z9746 | 01 | AZ | HEALTHNET | OTHER | 829796 | 05 | AZ |   | MEDICAID | AZ0278730 | 01 | AZ | BCBS | OTHER | 319237 | 01 | AZ | AHCCCS ID | OTHER |