Provider Demographics
NPI:1497978019
Name:VALLEY WOMEN'S HEALTH GROUP, LLC
Entity Type:Organization
Organization Name:VALLEY WOMEN'S HEALTH GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KOZIARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-781-8290
Mailing Address - Street 1:3550 MAIN ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1089
Mailing Address - Country:US
Mailing Address - Phone:413-781-8290
Mailing Address - Fax:413-732-7628
Practice Address - Street 1:3550 MAIN ST
Practice Address - Street 2:SUITE 302
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1089
Practice Address - Country:US
Practice Address - Phone:413-781-8290
Practice Address - Fax:413-732-7628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9780114Medicaid
MAM20320Medicare ID - Type Unspecified