Provider Demographics
NPI:1477514339
Name:VALLEY OSTOMY, INC
Entity Type:Organization
Organization Name:VALLEY OSTOMY, INC
Other - Org Name:LIFETIME HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ONTIVEROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-972-0244
Mailing Address - Street 1:3616 W PECAN BLVD
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-3511
Mailing Address - Country:US
Mailing Address - Phone:956-972-0244
Mailing Address - Fax:956-664-9933
Practice Address - Street 1:3616 W PECAN BLVD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-3511
Practice Address - Country:US
Practice Address - Phone:956-972-0244
Practice Address - Fax:956-664-9933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-30
Last Update Date:2011-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX010181802Medicaid
TX010181802Medicaid
TX1017810001Medicare ID - Type UnspecifiedMEDICARE PROVIDER #