Provider Demographics
NPI:1821084039
Name:MON VALLEY COMMUNITY HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:MON VALLEY COMMUNITY HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKEVITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-489-9100
Mailing Address - Street 1:2 EASTGATE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MONESSEN
Mailing Address - State:PA
Mailing Address - Zip Code:15062-1392
Mailing Address - Country:US
Mailing Address - Phone:724-684-8999
Mailing Address - Fax:
Practice Address - Street 1:2 EASTGATE AVE STE 101
Practice Address - Street 2:
Practice Address - City:MONESSEN
Practice Address - State:PA
Practice Address - Zip Code:15062-1392
Practice Address - Country:US
Practice Address - Phone:724-684-8999
Practice Address - Fax:724-684-7073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No251K00000XAgenciesPublic Health or WelfareGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007285210021Medicaid
PA391948Medicare Oscar/Certification