Provider Demographics
NPI:1417376195
Name:VALLEY MEDICAL CARE LLC
Entity Type:Organization
Organization Name:VALLEY MEDICAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARIF
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-942-3756
Mailing Address - Street 1:980 HIGHWAY 28
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JASPER
Mailing Address - State:TN
Mailing Address - Zip Code:37347-3695
Mailing Address - Country:US
Mailing Address - Phone:423-939-1500
Mailing Address - Fax:423-939-1503
Practice Address - Street 1:980 HIGHWAY 28
Practice Address - Street 2:SUITE 100
Practice Address - City:JASPER
Practice Address - State:TN
Practice Address - Zip Code:37347-3695
Practice Address - Country:US
Practice Address - Phone:423-939-1500
Practice Address - Fax:423-939-1503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-10
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN026768208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL161481Medicaid
TNQ012469Medicaid
TNQ012469Medicaid
TN3096189Medicare PIN