Provider Demographics
NPI:1154066256
Name:VALLEY INSTITUTE OF PRIMARY MEDICAL CARE OF ALABAMA, LLC
Entity Type:Organization
Organization Name:VALLEY INSTITUTE OF PRIMARY MEDICAL CARE OF ALABAMA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:KOBINA
Authorized Official - Last Name:QUANSAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-227-4478
Mailing Address - Street 1:241 MILL WALK CT
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-1565
Mailing Address - Country:US
Mailing Address - Phone:915-227-1977
Mailing Address - Fax:
Practice Address - Street 1:2828 HIGHWAY 31 S STE 104
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-1538
Practice Address - Country:US
Practice Address - Phone:915-227-1977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty