Provider Demographics
NPI:1073603122
Name:VALLEY HEALTHCARE ASSOCIATES, S.C
Entity Type:Organization
Organization Name:VALLEY HEALTHCARE ASSOCIATES, S.C
Other - Org Name:PRAIRIEVIEW MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:ELSNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-208-3992
Mailing Address - Street 1:905 NORTH FIRST ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:ELBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60119-9115
Mailing Address - Country:US
Mailing Address - Phone:630-365-4034
Mailing Address - Fax:630-365-4026
Practice Address - Street 1:905 NORTH FIRST ST
Practice Address - Street 2:SUITE C
Practice Address - City:ELBURN
Practice Address - State:IL
Practice Address - Zip Code:60119-9115
Practice Address - Country:US
Practice Address - Phone:630-365-4034
Practice Address - Fax:630-365-4036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04521619OtherBCBS
ILF79715Medicare UPIN