1669434502 NPI number — VALLEY NEUROLOGICAL SURGERY PC

Table of content: (NPI 1669434502)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669434502 NPI number — VALLEY NEUROLOGICAL SURGERY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY NEUROLOGICAL SURGERY PC
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:
1669434502
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 789
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUDLOW
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01056-0789
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-509-1000
Provider Business Mailing Address Fax Number:
413-509-1003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 STAFFORD ST
Provider Second Line Business Practice Location Address:
SUITE 264
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01104-3581
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-827-8800
Provider Business Practice Location Address Fax Number:
413-827-8811
Provider Enumeration Date:
04/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KAYE
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
413-827-8800

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  71211 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3053245 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: J08850 . This is a "BLUE SHIELD OF MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 751015 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 102900800 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 122410 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 98128001 . This is a "NETWORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 712110 . This is a "CONNECTICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 088468683 . This is a "TRICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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