Provider Demographics
NPI:1063980886
Name:VALLEY GASTROENTEROLOGY PLLC
Entity type:Organization
Organization Name:VALLEY GASTROENTEROLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MEDLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LARKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:989-791-9133
Mailing Address - Street 1:4680 MCLEOD DR E
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2852
Mailing Address - Country:US
Mailing Address - Phone:989-791-9133
Mailing Address - Fax:989-791-9135
Practice Address - Street 1:4680 MCLEOD DR E
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2852
Practice Address - Country:US
Practice Address - Phone:989-791-9133
Practice Address - Fax:989-791-9135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-09
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty