Provider Demographics
NPI:1689688335
Name:MID-VALLEY PULMONARY MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:MID-VALLEY PULMONARY MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO, VP
Authorized Official - Prefix:
Authorized Official - First Name:NECHEMIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:PELEG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-325-0200
Mailing Address - Street 1:4955 VAN NUYS BLVD
Mailing Address - Street 2:#502
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1817
Mailing Address - Country:US
Mailing Address - Phone:818-325-0200
Mailing Address - Fax:818-325-0210
Practice Address - Street 1:4955 VAN NUYS BLVD
Practice Address - Street 2:#502
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1817
Practice Address - Country:US
Practice Address - Phone:818-325-0200
Practice Address - Fax:818-325-0210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RG0100X, 207RP1001X
CA0870516207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0022520Medicaid
8727834Medicare PIN