Healthcare Provider Details

I. General information

NPI: 1013388271
Provider Name (Legal Business Name): MON VALE CLINICAL PROFESSIONALS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2015
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1163 COUNTRY CLUB RD
MONONGAHELA PA
15063-1013
US

IV. Provider business mailing address

1163 COUNTRY CLUB RD
MONONGAHELA PA
15063-1013
US

V. Phone/Fax

Practice location:
  • Phone: 724-258-1160
  • Fax:
Mailing address:
  • Phone: 724-258-1160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL F SIMMONS
Title or Position: SR. VICE PRESIDENT/TREASURER
Credential: CPA
Phone: 724-258-1160