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General NPI Number Information
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NPI Number | 1982844866
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Entity Type | Organization
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Legal Business Name | VALLEY MEDICAL LLC
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Dates
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Enumeration Date | 03/04/2009
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Last Update Date | 01/17/2012
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Provider Practice Location Address
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Address Line | 2065 E. FAIRVIEW AVE.
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City | MERIDIAN
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State | ID
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Zip | 83642-5798
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Country | US
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Telephone | 208-955-7491
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Fax | 208-955-7492
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Provider Business Mailing Address
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Address Line | 2065 E. FAIRVIEW AVE.
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City | MERIDIAN
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State | ID
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Zip | 83642-5798
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Country | US
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Telephone | 208-955-7491
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Fax | 208-955-7492
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Authorized Official
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Title or Position | MANGING MEMBER
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Name | MR. JASON A. MONKS
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Credential |
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Telephone | 208-955-7491
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number |
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License Number State |
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