Provider Demographics
NPI:1710399472
Name:VALLEY OBSTETRICS AND GYNECOLOGY, P.C.
Entity Type:Organization
Organization Name:VALLEY OBSTETRICS AND GYNECOLOGY, P.C.
Other - Org Name:SPRINGVILLE GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTRACT & CREDENTIALING SPEC
Authorized Official - Prefix:
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-628-0498
Mailing Address - Street 1:285 E 400 S
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-1957
Mailing Address - Country:US
Mailing Address - Phone:801-489-0111
Mailing Address - Fax:801-489-8351
Practice Address - Street 1:285 E 400 S
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-1957
Practice Address - Country:US
Practice Address - Phone:801-489-0111
Practice Address - Fax:801-489-8351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1376645887207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1376645887OtherNPI