Organization
MARYVALE FACILITY GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHALLEN WAYCHOFF III (COO/MANAGER)
(480) 634-6400
Entity
Organization
Contact information
Practice address
7141 W THOMAS RD STE 102, PHOENIX, AZ 85033-5518
(480) 634-6400
(480) 404-9649
Mailing address
3724 N 3RD ST STE 301, PHOENIX, AZ 85012-2035
(480) 634-6400
(480) 404-9649
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
04/19/2019
Last updated
05/03/2019
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