Basic Information
| Provider Information | |||||||||
| NPI: | 1881014751 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VALOR HEALTH SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1048 E FRY BLVD | ||||||||
| Address2: | SUITE E | ||||||||
| City: | SIERRA VISTA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856352683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5204589450 | ||||||||
| FaxNumber: | 5204589455 | ||||||||
| Practice Location | |||||||||
| Address1: | 1048 E FRY BLVD | ||||||||
| Address2: | SUITE E | ||||||||
| City: | SIERRA VISTA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856352683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5204589450 | ||||||||
| FaxNumber: | 5204589455 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2014 | ||||||||
| LastUpdateDate: | 09/29/2016 | ||||||||
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| AuthorizedOfficialLastName: | ROWE | ||||||||
| AuthorizedOfficialFirstName: | GRANT | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CHAIRMAN & CEO | ||||||||
| AuthorizedOfficialTelephone: | 5205292971 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0505X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine |
No ID Information.