NPIMap

Organization Active NPI

Associated Valley Providers PLLC

  • Family Medicine Physician
  • Renton, WA
National Provider Identifier
1043490543
Registry record updated Sep 22, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ASSOCIATED VALLEY PROVIDERS PLLC
Practice address
4361 Talbot Rd S
Suite 112
Renton, WA 98055-6226
Phone
(425) 255-5111
Fax
(425) 254-0985
NPI assigned
Nov 13, 2007
Last updated
Sep 22, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. John L Vanderheyden, M.D.NPI 1578623690
Title
Owner
Phone
(425) 255-5111

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X WA Primary
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X WA
Foot & Ankle Surgery PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213ES0103X WA
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X WA

Addresses

Primary practice location

4361 Talbot Rd S
Suite 112
Renton, WA 98055-6226

Mailing address

4361 Talbot Rd S
Suite 112
Renton, WA 98055-6226
Phone (425) 255-5111

Other identifiers 1

IdentifierTypeStateIssuer
7112634MedicaidWA

National Provider Directory

National Provider Directory

Locations

4361 Talbot Rd S
Ste 112
Renton, WA 98055
Phone (425) 255-5111

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1194912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1253577600000",
    "number": "1043490543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4361 TALBOT RD S",
            "address_2": "SUITE 112",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980556226",
            "telephone_number": "425-255-5111",
            "fax_number": "425-254-0985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4361 TALBOT RD S",
            "address_2": "SUITE 112",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980556226",
            "telephone_number": "425-255-5111",
            "fax_number": "425-254-0985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASSOCIATED VALLEY PROVIDERS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-13",
        "last_updated": "2009-09-22",
        "status": "A",
        "authorized_official_last_name": "VANDERHEYDEN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "425-255-5111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "WA",
            "license": null,
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "WA",
            "license": null,
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "WA",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "WA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7112634",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Renton, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.