Provider Demographics
NPI:1831489327
Name:MON-VALE ONCOLOGY, INC.
Entity Type:Organization
Organization Name:MON-VALE ONCOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL/AUTHORIZED OFFIC
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOURDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STRISHOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-375-6160
Mailing Address - Street 1:100 HOSPITAL AVE
Mailing Address - Street 2:ATTN PROVIDER ENROLLMENT
Mailing Address - City:DUBOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1440
Mailing Address - Country:US
Mailing Address - Phone:724-986-0698
Mailing Address - Fax:814-372-2676
Practice Address - Street 1:1163 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:MONONGAHELA
Practice Address - State:PA
Practice Address - Zip Code:15063-1013
Practice Address - Country:US
Practice Address - Phone:724-292-9404
Practice Address - Fax:724-292-9155
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONONGAHELA VALLEY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-18
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X, 207RH0003X
PAMD434187174400000X
PAVP006402M363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1525897OtherGATEWAY
PA130506OtherUNISON
PA1019980110001Medicaid
PA085188OtherHEALTH AMERICA/HEALTH ASSURANCE
PA2937436OtherAETNA
PA2937436OtherAETNA