Provider Demographics
NPI:1497801245
Name:VALUE MEDICAL, INC
Entity Type:Organization
Organization Name:VALUE MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:BRADY
Authorized Official - Last Name:STOUGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:JURIS DOCTOR
Authorized Official - Phone:404-475-1202
Mailing Address - Street 1:107 KIOWA LN
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:SC
Mailing Address - Zip Code:29673-6751
Mailing Address - Country:US
Mailing Address - Phone:800-861-4965
Mailing Address - Fax:888-448-1725
Practice Address - Street 1:107 KIOWA LN
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:SC
Practice Address - Zip Code:29673-6751
Practice Address - Country:US
Practice Address - Phone:800-861-4965
Practice Address - Fax:888-448-1725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA812677065AMedicaid
KY90062605Medicaid
NM000Z4355Medicaid
MD406066100Medicaid
PA7169610Medicaid
SCDM0832Medicaid
NM000Z4355Medicaid
ID=========Medicaid