Provider Demographics
NPI:1639610132
Name:MON-VALE SPECIALTY PRACTICES, INC
Entity Type:Organization
Organization Name:MON-VALE SPECIALTY PRACTICES, INC
Other - Org Name:MON-VALE NEPHROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-258-1106
Mailing Address - Street 1:1163 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:MONONGAHELA
Mailing Address - State:PA
Mailing Address - Zip Code:15063-1013
Mailing Address - Country:US
Mailing Address - Phone:724-258-1106
Mailing Address - Fax:
Practice Address - Street 1:100 STOOPS DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MONONGAHELA
Practice Address - State:PA
Practice Address - Zip Code:15063-3553
Practice Address - Country:US
Practice Address - Phone:724-483-4083
Practice Address - Fax:855-475-6063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty