Provider Demographics
NPI:1740225598
Name:VALLEY MEDICAL CENTER P.C.
Entity Type:Organization
Organization Name:VALLEY MEDICAL CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:BERNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-892-7722
Mailing Address - Street 1:308 S HARRIS ST
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:65793-1621
Mailing Address - Country:US
Mailing Address - Phone:417-469-3175
Mailing Address - Fax:989-892-7455
Practice Address - Street 1:308 S HARRIS ST
Practice Address - Street 2:
Practice Address - City:WILLOW SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:65793-1621
Practice Address - Country:US
Practice Address - Phone:417-469-3175
Practice Address - Fax:417-469-1274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205784OtherBLUE CROSS
MO598649408Medicaid
MO112904OtherBLUE CROSS
263871OtherCAHABA GBA
P00163042OtherRAIL ROAD MEDICARE
MO598649408Medicaid