Provider Demographics
NPI:1568424323
Name:UPPER VALLEY MEDICAL CENTER AUXILIARY
Entity Type:Organization
Organization Name:UPPER VALLEY MEDICAL CENTER AUXILIARY
Other - Org Name:UPPER VALLEY MEDICAL CENTER LIFELINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAIBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-440-4000
Mailing Address - Street 1:3130 N DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-1337
Mailing Address - Country:US
Mailing Address - Phone:937-440-7790
Mailing Address - Fax:937-440-7886
Practice Address - Street 1:3130 N DIXIE HWY
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-1337
Practice Address - Country:US
Practice Address - Phone:937-440-7790
Practice Address - Fax:937-440-7886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========OtherDURABLE MEDICAL EQUIPMEN