Provider Demographics
NPI:1093743684
Name:VALLEY SURGEONS, INC
Entity Type:Organization
Organization Name:VALLEY SURGEONS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:DUKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-539-8725
Mailing Address - Street 1:1015 FRANKLIN ST
Mailing Address - Street 2:LEVEL C, WESSEL BLDG
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-4110
Mailing Address - Country:US
Mailing Address - Phone:814-539-8725
Mailing Address - Fax:814-539-6336
Practice Address - Street 1:1015 FRANKLIN ST
Practice Address - Street 2:LEVEL C, WESSEL BLDG
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-4110
Practice Address - Country:US
Practice Address - Phone:814-539-8725
Practice Address - Fax:814-539-6336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD010941E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006411310001Medicaid
PA021350OtherHIGHMARK GROUP ACCOUNT