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General NPI Number Information
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NPI Number | 1245219351
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Entity Type | Organization
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Legal Business Name | VALLEY MEDICAL ASSOCIATION
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Dates
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Enumeration Date | 01/17/2006
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Last Update Date | 05/17/2011
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Provider Practice Location Address
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Address Line | 384 MAIN ST
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City | ST AGATHA
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State | ME
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Zip | 04772
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Country | US
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Telephone | 207-543-7567
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Fax |
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Provider Business Mailing Address
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Address Line | 194 E MAIN ST
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City | FORT KENT
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State | ME
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Zip | 04743
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Country | US
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Telephone | 207-834-5877
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Fax | 207-834-2522
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Authorized Official
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Title or Position | CEO
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Name | MR. PETER SIROIS
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Credential |
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Telephone | 207-834-1408
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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