Healthcare Provider Details

I. General information

NPI: 1699027854
Provider Name (Legal Business Name): MON-VALE SPECIALTY PRACTICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2012
Last Update Date: 01/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 FAYETTE STREET
BELLE VERNON PA
15012
US

IV. Provider business mailing address

1163 COUNTRY CLUB RD ATTENTION: DANIEL SIMMONS
MONONGAHELA PA
15063-1013
US

V. Phone/Fax

Practice location:
  • Phone: 724-929-4122
  • Fax: 724-929-5188
Mailing address:
  • Phone: 724-258-1106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL SIMMONS
Title or Position: SECRETATY/TREASURER
Credential:
Phone: 724-258-1106