Provider Demographics
NPI:1518957059
Name:UPPER VALLEY FAMILY CARE, INC
Entity Type:Organization
Organization Name:UPPER VALLEY FAMILY CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAUFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-339-8060
Mailing Address - Street 1:200 KIENLE DR
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-4120
Mailing Address - Country:US
Mailing Address - Phone:937-339-8060
Mailing Address - Fax:937-773-9810
Practice Address - Street 1:200 KIENLE DR
Practice Address - Street 2:
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-4120
Practice Address - Country:US
Practice Address - Phone:937-339-8060
Practice Address - Fax:937-773-9810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0622535Medicaid
OH0622535Medicaid
OH9915106Medicare PIN