Provider Demographics
NPI:1154379964
Name:VALLEY PRIMARY CARE ASSOCIATES LLC
Entity type:Organization
Organization Name:VALLEY PRIMARY CARE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:J
Authorized Official - Last Name:KEYS-FREZZELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-684-7500
Mailing Address - Street 1:1295 GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:MONESSEN
Mailing Address - State:PA
Mailing Address - Zip Code:15062
Mailing Address - Country:US
Mailing Address - Phone:724-684-7500
Mailing Address - Fax:724-684-5744
Practice Address - Street 1:1295 GRAND BLVD
Practice Address - Street 2:
Practice Address - City:MONESSEN
Practice Address - State:PA
Practice Address - Zip Code:15062
Practice Address - Country:US
Practice Address - Phone:724-684-7500
Practice Address - Fax:724-684-5744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1010168950001Medicaid
PA1661030Medicaid
I02475Medicare UPIN
PA1661030Medicaid
PA416391NDCMedicare ID - Type Unspecified
PA077164NDCMedicare ID - Type Unspecified