Provider Demographics
NPI:1619166105
Name:VALLEY FORGE FAMILY PHYSICIANS
Entity Type:Organization
Organization Name:VALLEY FORGE FAMILY PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:BAER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-444-8447
Mailing Address - Street 1:50 VALLEY FORGE RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61571-2372
Mailing Address - Country:US
Mailing Address - Phone:309-444-8447
Mailing Address - Fax:309-444-2003
Practice Address - Street 1:50 VALLEY FORGE RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IL
Practice Address - Zip Code:61571-2372
Practice Address - Country:US
Practice Address - Phone:309-444-8447
Practice Address - Fax:309-444-2003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL774060Medicare PIN