1558406512 NPI number — VALLEY MEDICAL GROUP, P.C.

Table of content: (NPI 1558406512)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558406512 NPI number — VALLEY MEDICAL GROUP, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY MEDICAL GROUP, P.C.
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 GROUP PT
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:
1558406512
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5700
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELFAST
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04915-5700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-431-4077
Provider Business Mailing Address Fax Number:
413-774-7448

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
329 CONWAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01301-1526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-774-6301
Provider Business Practice Location Address Fax Number:
413-774-6528
Provider Enumeration Date:
02/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CARLAN
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
413-772-3313

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XH1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 683464 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9787151 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: Y61239 . This is a "BLUE CROSS BLUE SHIELD OF" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 712451 . This is a "CONNECTICARE, INC." identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 24189 . This is a "HEALTH NEW ENGLAND" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 626166 . This is a "HARVARD PILGRIM HEALTH PL" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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