1437275955 NPI number — VALLEY INTERNAL MEDICINE ASSOCIATES PLLC

Table of content: (NPI 1437275955)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437275955 NPI number — VALLEY INTERNAL MEDICINE ASSOCIATES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY INTERNAL MEDICINE ASSOCIATES PLLC
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:
SATHIYARAJ GEORGE MDPA
Provider Other Organization Name Type Code:
4
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:
1437275955
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1616 E GRIFFIN PKWY PMB 158
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MISSION
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78572-3180
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-583-7393
Provider Business Mailing Address Fax Number:
956-583-7309

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2121 E GRIFFIN PKWY
Provider Second Line Business Practice Location Address:
STE 10
Provider Business Practice Location Address City Name:
MISSION
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78572-3241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-583-7393
Provider Business Practice Location Address Fax Number:
956-583-7309
Provider Enumeration Date:
03/22/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GEORGE
Authorized Official First Name:
SATHIYARAJ
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
956-583-7393

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  K4433 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 163349701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".