Healthcare Provider Details

I. General information

NPI: 1639405582
Provider Name (Legal Business Name): MONVALEORTHOPEDICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2009
Last Update Date: 06/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 LINCOLN AVE PROFESSIONAL PLAZA, SUITE 107
CHARLEROI PA
15022-2451
US

IV. Provider business mailing address

800 PLAZA DR SUITE 400
BELLE VERNON PA
15012-4019
US

V. Phone/Fax

Practice location:
  • Phone: 724-483-4880
  • Fax: 724-483-9414
Mailing address:
  • Phone: 724-379-5816
  • Fax: 724-379-5874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: AMANDA FERGUSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 724-379-5802