MEDICARE: VALLEY MEDICAL CENTER P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center
2	207Q00000X	Family Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00163042	OTHER		RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	205784	OTHER	MO	BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	112904	OTHER	MO	BLUE CROSS
4	263871	OTHER		CAHABA GBA

General Provider Information

NPI Number	:	1740225598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY MEDICAL CENTER P.C.

Provider Business Mailing Address
First Line	:	308 S HARRIS ST
Second Line	:
City	:	WILLOW SPRINGS
State	:	MO
Zip	:	65793-1621
Country	:	US
Telephone Number	:	417-469-3175
Fax Number	:	989-892-7455

Provider Business Practice Location Address
First Line	:	308 S HARRIS ST
Second Line	:
City	:	WILLOW SPRINGS
State	:	MO
Zip	:	65793-1621
Country	:	US
Telephone Number	:	417-469-3175
Fax Number	:	417-469-1274

Authorized Official
Title or Position	:	CLINIC ADMINISTRATOR
Name	:	MR. WILLIAM E BERNER
Credential	:
Telephone Number	:	989-892-7722

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	08/20/2014

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Directions to “VALLEY MEDICAL CENTER P.C. ” Practice Location

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