Provider Demographics
NPI:1659571602
Name:VALENA & VALENA PC
Entity Type:Organization
Organization Name:VALENA & VALENA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-288-6387
Mailing Address - Street 1:818 W WHITE RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-3868
Mailing Address - Country:US
Mailing Address - Phone:765-288-6387
Mailing Address - Fax:765-288-6079
Practice Address - Street 1:818 W WHITE RIVER BLVD
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-3868
Practice Address - Country:US
Practice Address - Phone:765-288-6387
Practice Address - Fax:765-288-6079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01033721A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200432010AMedicaid
INP00019050OtherRAILROAD MEDICARE
INP00019050OtherRAILROAD MEDICARE