Provider Demographics
NPI:1417051608
Name:VALLEY MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:VALLEY MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHORTELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-732-4269
Mailing Address - Street 1:49 PERSHING DR
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:CT
Mailing Address - Zip Code:06418
Mailing Address - Country:US
Mailing Address - Phone:203-732-4269
Mailing Address - Fax:203-732-4062
Practice Address - Street 1:49 PERSHING DR
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418
Practice Address - Country:US
Practice Address - Phone:203-732-4269
Practice Address - Fax:203-732-4062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
12DME0182CT01OtherANTHEM BLUE CROSS SHEILD
ANC1664OtherOXFORD HEALTH PLANS
ANC1664OtherOXFORD HEALTH PLANS