Organization
WEST VALLEY CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAM T TYSON M.D. (COO/MANAGER)
(915) 877-3151
Entity
Organization
Contact information
Practice address
6898 DONIPHAN DRIVE, CANUTILLO, TX 79835-2076
(915) 877-3151
(915) 877-5346
Mailing address
6898 DONIPHAN DRIVE, P.O BOX 2076, CANUTILLO, TX 79835-2076
(915) 877-3151
(915) 877-5346
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
H2185
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
138392907
—
TX
Enumeration date
01/05/2012
Last updated
09/10/2020
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