Provider Demographics
NPI:1154736619
Name:MON-VALE SPECIALTY PRACTICES, INC
Entity type:Organization
Organization Name:MON-VALE SPECIALTY PRACTICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-258-1106
Mailing Address - Street 1:1163 COUNTRY CLUB RD
Mailing Address - Street 2:ATTENTION DANIEL SIMMONS
Mailing Address - City:MONONGAHELA
Mailing Address - State:PA
Mailing Address - Zip Code:15063-1013
Mailing Address - Country:US
Mailing Address - Phone:724-258-1106
Mailing Address - Fax:
Practice Address - Street 1:2001 WATERDAM PLAZA DR
Practice Address - Street 2:SUITE 108
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-5416
Practice Address - Country:US
Practice Address - Phone:724-942-0010
Practice Address - Fax:724-942-0040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD023828E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty