Healthcare Provider Details

I. General information

NPI: 1528068244
Provider Name (Legal Business Name): VALACH NEPHROLOGY, HYPERTENSION AND INTERNAL MEDICINE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 07/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 HIGHWAY 201 N SUITE 1
MOUNTAIN HOME AR
72653-2425
US

IV. Provider business mailing address

1409 HIGHWAY 201 N SUITE 1
MOUNTAIN HOME AR
72653-2425
US

V. Phone/Fax

Practice location:
  • Phone: 870-508-5010
  • Fax: 870-508-5020
Mailing address:
  • Phone: 870-508-5010
  • Fax: 870-508-5020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number16660
License Number StateAR

VIII. Authorized Official

Name: DANIEL PESEK VALACH
Title or Position: NEPHROLOGIST
Credential: M.D.
Phone: 870-508-5010