Healthcare Provider Details

I. General information

NPI: 1073603122
Provider Name (Legal Business Name): VALLEY HEALTHCARE ASSOCIATES, S.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 11/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 NORTH FIRST ST SUITE C
ELBURN IL
60119-9115
US

IV. Provider business mailing address

905 NORTH FIRST ST SUITE C
ELBURN IL
60119-9115
US

V. Phone/Fax

Practice location:
  • Phone: 630-365-4034
  • Fax: 630-365-4036
Mailing address:
  • Phone: 630-365-4034
  • Fax: 630-365-4026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES ELSNER
Title or Position: PRESIDENT
Credential:
Phone: 630-208-3992