1699027854 NPI number — MON-VALE SPECIALTY PRACTICES, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699027854 NPI number — MON-VALE SPECIALTY PRACTICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MON-VALE SPECIALTY PRACTICES, 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:
CRUDO GONZALEZ SURGICAL ASSOCIATES
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:
1699027854
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1163 COUNTRY CLUB RD
Provider Second Line Business Mailing Address:
ATTENTION: DANIEL SIMMONS
Provider Business Mailing Address City Name:
MONONGAHELA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15063-1013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-258-1106
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 FAYETTE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLE VERNON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-929-4122
Provider Business Practice Location Address Fax Number:
724-929-5188
Provider Enumeration Date:
10/11/2012

Additional Information

Authorized Official

Authorized Official Last Name:
SIMMONS
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
SECRETATY/TREASURER
Authorized Official Telephone Number:
724-258-1106

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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