Healthcare Provider Details

I. General information

NPI: 1235334517
Provider Name (Legal Business Name): VALLEY SURGICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 EDWARDS VILLAGE BLVD SUITE A203
EDWARDS CO
81632-9914
US

IV. Provider business mailing address

8135 N MILWAUKEE AVE
NILES IL
60714-2828
US

V. Phone/Fax

Practice location:
  • Phone: 970-949-3350
  • Fax: 970-797-1245
Mailing address:
  • Phone: 847-967-8098
  • Fax: 847-967-8594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KENNETH J. ALLAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 970-949-3350