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General NPI Number Information
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NPI Number | 1215673330
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Entity Type | Organization
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Legal Business Name | VALLEY INSTITUTE OF PRIMARY MEDICAL CARE OF ALABAMA
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Dates
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Enumeration Date | 05/11/2022
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Last Update Date | 05/11/2022
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Provider Practice Location Address
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Address Line | 2828 US-31, SUIT 104
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City | DECATUR
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State | AL
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Zip | 36603-3575
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Country | US
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Telephone | 915-227-1977
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Fax |
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Provider Business Mailing Address
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Address Line | 241 MILL WALK CT
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City | MADISON
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State | AL
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Zip | 35758-1565
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Country | US
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Telephone | 915-227-1977
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Fax |
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Authorized Official
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Title or Position | EMPLOYEE
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Name | RAPHAEL QUANSAH
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Credential | MD
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Telephone | 915-227-1977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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