1861497018 NPI number — VALLEY MEDICAL SUPPLY, INC.

Table of content: (NPI 1861497018)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861497018 NPI number — VALLEY MEDICAL SUPPLY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY MEDICAL SUPPLY, 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:
Provider Other Organization Name Type Code:
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:
1861497018
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
49 PERSHING DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DERBY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06418-1406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-732-4269
Provider Business Mailing Address Fax Number:
203-732-4062

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
49 PERSHING DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DERBY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06418-1406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-732-4269
Provider Business Practice Location Address Fax Number:
203-732-4062
Provider Enumeration Date:
06/15/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MARRO
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
V
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
203-732-4269

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 12DME0182CT01 . This is a "ANTHEM BLUE CROSS BLUE SH" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: ANC1664 . This is a "OXFORD HEALTH" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: BLUECARE FAMILY PLAN . This is a "00406954800" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".