Provider Demographics
NPI:1467815282
Name:MISSISSIPPI VALLEY I STONE MANAGEMENT, LP
Entity Type:Organization
Organization Name:MISSISSIPPI VALLEY I STONE MANAGEMENT, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-356-5290
Mailing Address - Street 1:1700 W PARK DR
Mailing Address - Street 2:SUITE 410
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-3939
Mailing Address - Country:US
Mailing Address - Phone:410-356-5290
Mailing Address - Fax:410-356-5292
Practice Address - Street 1:2801 GATEWAY DR
Practice Address - Street 2:SUITE 100
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-6082
Practice Address - Country:US
Practice Address - Phone:410-356-5290
Practice Address - Fax:410-356-5292
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITED MEDICAL SYSTEMS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QL0400XAmbulatory Health Care FacilitiesClinic/CenterLithotripsy