NPIMap

Organization Active NPI

Layne Sandridge MD, PLC

Doing business as Valley Vascular Specialists

  • Vascular Surgery Physician
  • Glendale, AZ
National Provider Identifier
1497253546
Registry record updated Mar 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
Legal business name
LAYNE SANDRIDGE MD, PLC
Doing business as
Valley Vascular Specialists
Practice address
18700 N 64TH Dr Ste 105a
Glendale, AZ 85308-7110
Phone
(623) 688-5075
Fax
(623) 688-5075
NPI assigned
Jan 23, 2018
Last updated
Mar 21, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2019

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

Authorized official

Name
Layne C. Sandridge, MDNPI 1063689909
Title
Physician/Practice Owner
Phone
(623) 688-5075

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X Primary

Addresses

Primary practice location

18700 N 64TH Dr Ste 105a
Glendale, AZ 85308-7110

Mailing address

19801 N 59TH Ave
#11659
Glendale, AZ 85318
Phone (623) 688-5075

Other identifiers 1

IdentifierTypeStateIssuer
443661MedicaidAZ

Other names 1

  • Valley Vascular Specialists Doing business as

National Provider Directory

National Provider Directory

Locations

19801 N 59th Ave
Unit 11659
Glendale, AZ 85318

Practitioners & affiliated clinicians

Practitioners 1

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": "1516665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553126400000",
    "number": "1497253546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19801 N 59TH AVE",
            "address_2": "#11659",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "85318",
            "telephone_number": "623-688-5075",
            "fax_number": "602-842-9970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18700 N 64TH DR STE 105A",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853087110",
            "telephone_number": "623-688-5075",
            "fax_number": "623-688-5075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAYNE SANDRIDGE MD, PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-23",
        "last_updated": "2019-03-21",
        "status": "A",
        "authorized_official_last_name": "SANDRIDGE",
        "authorized_official_first_name": "LAYNE",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "PHYSICIAN/PRACTICE OWNER",
        "authorized_official_telephone_number": "623-688-5075",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "443661",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Valley Vascular Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glendale, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 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.