Provider Demographics
NPI:1558358127
Name:VALLEY ORTHOPEDICS INC
Entity Type:Organization
Organization Name:VALLEY ORTHOPEDICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:RIDELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-535-5554
Mailing Address - Street 1:1111 FRANKLIN ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-4330
Mailing Address - Country:US
Mailing Address - Phone:814-535-5554
Mailing Address - Fax:814-535-5255
Practice Address - Street 1:1111 FRANKLIN ST
Practice Address - Street 2:SUITE 140
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-4330
Practice Address - Country:US
Practice Address - Phone:814-535-5554
Practice Address - Fax:814-535-5255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD018887E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006410600002Medicaid
PA159397Medicare PIN
PACF7004Medicare PIN