1063422053 NPI number — VALLEY MEDICAL FACILITIES INC

Table of content: (NPI 1063422053)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063422053 NPI number — VALLEY MEDICAL FACILITIES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY MEDICAL FACILITIES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
VALLEY MEDICAL FACILITIES INC DBA HERITAGE VALLEY BEAVER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063422053
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 DUTCH RIDGE RD
Provider Second Line Business Mailing Address:
EXECUTIVE OFFICES
Provider Business Mailing Address City Name:
BEAVER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15009-9727
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-773-2014
Provider Business Mailing Address Fax Number:
724-773-8210

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 DUTCH RIDGE RD
Provider Second Line Business Practice Location Address:
EXECUTIVE OFFICES
Provider Business Practice Location Address City Name:
BEAVER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15009-9727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-773-2014
Provider Business Practice Location Address Fax Number:
724-773-8210
Provider Enumeration Date:
08/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROSENBERGER
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
724-773-4730

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  135701 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1000033550174 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0112489 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104424 . This is a "UPMC HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 6490160 . This is a "AETNA PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1003637 . This is a "GATWAY- MA MANAGED CARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 9823 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 014 . This is a "HIGHMARK- COMMERICAL INS." identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0001625000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 41828 . This is a "COVENTRY- COMMERCIAL INS." identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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