Provider Demographics
NPI:1821047671
Name:VALLEY SURGICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:VALLEY SURGICAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:SENTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-745-8100
Mailing Address - Street 1:2490 S WOODWORTH LOOP
Mailing Address - Street 2:SUITE 450
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-7405
Mailing Address - Country:US
Mailing Address - Phone:907-745-8100
Mailing Address - Fax:907-746-2655
Practice Address - Street 1:2490 S WOODWORTH LOOP
Practice Address - Street 2:SUITE 450
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-7405
Practice Address - Country:US
Practice Address - Phone:907-745-8100
Practice Address - Fax:907-746-2655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1660208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD1660Medicaid
AKK0000WCJQLBMedicare PIN
AKMD1660Medicaid