Provider Demographics
NPI:1528127610
Name:VALLEY MEDICAL PRIMARY CARE, INC
Entity type:Organization
Organization Name:VALLEY MEDICAL PRIMARY CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEENAKSHI
Authorized Official - Middle Name:C
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-208-8280
Mailing Address - Street 1:6611 CLYO RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-2786
Mailing Address - Country:US
Mailing Address - Phone:937-208-8280
Mailing Address - Fax:937-208-8276
Practice Address - Street 1:6611 CLYO RD
Practice Address - Street 2:SUITE E
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-2786
Practice Address - Country:US
Practice Address - Phone:937-208-8280
Practice Address - Fax:937-208-8276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9324321Medicare PIN
OH9324321Medicare UPIN