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General NPI Number Information
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NPI Number | 1144673039
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Entity Type | Organization
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Legal Business Name | VALLEY FAMILY MEDICINE S.C.
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Dates
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Enumeration Date | 07/15/2016
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Last Update Date | 07/15/2016
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Provider Practice Location Address
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Address Line | 1505 MILL ST
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City | NEW LONDON
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State | WI
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Zip | 54961-2187
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Country | US
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Telephone | 920-982-7900
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Fax | 920-982-7995
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Provider Business Mailing Address
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Address Line | 1505 MILL ST
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City | NEW LONDON
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State | WI
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Zip | 54961-2187
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Country | US
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Telephone | 920-982-7900
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Fax | 920-982-7995
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRIAN L VAN HOOZEN
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Credential | D.O.
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Telephone | 920-982-7900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 3269921
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License Number State | WI
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