1639610132 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 1639610132 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:
Provider Other Organization Name Type Code:
6
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:
1639610132
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2017
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:
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:
100 STOOPS DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
MONONGAHELA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15063-3553
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-483-4083
Provider Business Practice Location Address Fax Number:
855-475-6063
Provider Enumeration Date:
03/16/2017

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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