Provider Demographics
NPI:1790899714
Name:MON-VALLEY EKG ASSOCIATES
Entity Type:Organization
Organization Name:MON-VALLEY EKG ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:R
Authorized Official - Middle Name:G
Authorized Official - Last Name:KRISHNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-258-8040
Mailing Address - Street 1:PO BOX 28
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301
Mailing Address - Country:US
Mailing Address - Phone:724-228-3400
Mailing Address - Fax:724-228-7040
Practice Address - Street 1:COUNTRY CLUB RD
Practice Address - Street 2:MONONGAHELA VALLEY HOSPITAL
Practice Address - City:MONONGAHELA
Practice Address - State:PA
Practice Address - Zip Code:15063
Practice Address - Country:US
Practice Address - Phone:724-258-8040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001280642001Medicaid
PA718693Medicare ID - Type Unspecified