Provider Demographics
NPI:1215464417
Name:VALIDUS HEALTH, PA
Entity type:Organization
Organization Name:VALIDUS HEALTH, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KINGDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-300-2289
Mailing Address - Street 1:725 N MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-1623
Mailing Address - Country:US
Mailing Address - Phone:888-712-1047
Mailing Address - Fax:
Practice Address - Street 1:725 N MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-1623
Practice Address - Country:US
Practice Address - Phone:888-712-1047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP4471207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty