Provider Demographics
NPI:1710977244
Name:UPPER VALLEY FAMILY CARE INC
Entity Type:Organization
Organization Name:UPPER VALLEY FAMILY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAUFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-339-8060
Mailing Address - Street 1:700 S STANFIELD RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-2372
Mailing Address - Country:US
Mailing Address - Phone:937-339-8060
Mailing Address - Fax:937-339-3056
Practice Address - Street 1:700 S STANFIELD RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-2372
Practice Address - Country:US
Practice Address - Phone:937-339-8060
Practice Address - Fax:937-339-3056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0473492Medicaid
OH0473492Medicaid