Maryvale Facility Group LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

MARYVALE FACILITY GROUP LLC

Practice address

7141 W Thomas Rd Ste 102
Phoenix, AZ 85033-5518

Phone

(480) 634-6400

Fax

(480) 404-9649

NPI assigned

Apr 19, 2019

Organization subpart

No

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

Authorized official

Name

Mr. Challen Waychoff III

Title

Coo/Manager

Phone

(480) 634-6400

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1555632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556841600000",
    "number": "1053974592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3724 N 3RD ST STE 301",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122035",
            "telephone_number": "480-634-6400",
            "fax_number": "480-404-9649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7141 W THOMAS RD STE 102",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850335518",
            "telephone_number": "480-634-6400",
            "fax_number": "480-404-9649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYVALE FACILITY GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-19",
        "last_updated": "2019-05-03",
        "status": "A",
        "authorized_official_last_name": "WAYCHOFF",
        "authorized_official_first_name": "CHALLEN",
        "authorized_official_title_or_position": "COO/MANAGER",
        "authorized_official_telephone_number": "480-634-6400",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Phoenix, AZ
• Ambulatory Surgical Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2019; 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.