Provider Demographics
NPI:1043548886
Name:EAST VALLEY MEDICINE PLC
Entity type:Organization
Organization Name:EAST VALLEY MEDICINE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:R
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-883-1042
Mailing Address - Street 1:693 E TORREY PINES PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-6908
Mailing Address - Country:US
Mailing Address - Phone:480-883-1042
Mailing Address - Fax:480-305-5782
Practice Address - Street 1:4980 S ALMA SCHOOL RD
Practice Address - Street 2:SUITE A2 #194
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-5545
Practice Address - Country:US
Practice Address - Phone:480-883-1042
Practice Address - Fax:480-305-5782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-04
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32403208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty