Provider Demographics
NPI:1487194270
Name:MON VALLEY SURGICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:MON VALLEY SURGICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DENE
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:DAUGHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:814-590-2104
Mailing Address - Street 1:90 CHAMBER PLZ
Mailing Address - Street 2:
Mailing Address - City:CHARLEROI
Mailing Address - State:PA
Mailing Address - Zip Code:15022-1620
Mailing Address - Country:US
Mailing Address - Phone:724-565-1121
Mailing Address - Fax:
Practice Address - Street 1:90 CHAMBER PLZ
Practice Address - Street 2:
Practice Address - City:CHARLEROI
Practice Address - State:PA
Practice Address - Zip Code:15022-1620
Practice Address - Country:US
Practice Address - Phone:724-565-1121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS018443208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty