Healthcare Provider Details

I. General information

NPI: 1063948891
Provider Name (Legal Business Name): VALLEY MEDICAL CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 08/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 PARKS AVE
SCOTTSBORO AL
35768-2411
US

IV. Provider business mailing address

PO BOX 56 331 PARKS AVENUE
SCOTTSBORO AL
35768-0056
US

V. Phone/Fax

Practice location:
  • Phone: 256-451-1250
  • Fax: 256-451-1270
Mailing address:
  • Phone: 256-451-1250
  • Fax: 256-451-1270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MUHAMMAD E ATA
Title or Position: OWNER
Credential: MD
Phone: 256-451-1250