Provider Demographics
NPI:1851372460
Name:VALLEY INTERNAL MEDICINE AND PEDIATRICS
Entity Type:Organization
Organization Name:VALLEY INTERNAL MEDICINE AND PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:AKRAM
Authorized Official - Middle Name:IBRAHIEM
Authorized Official - Last Name:HAGGAG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-325-7425
Mailing Address - Street 1:708 WILL HALSEY WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-2565
Mailing Address - Country:US
Mailing Address - Phone:256-325-7425
Mailing Address - Fax:256-325-2465
Practice Address - Street 1:708 WILL HALSEY WAY
Practice Address - Street 2:SUITE A
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-2565
Practice Address - Country:US
Practice Address - Phone:256-325-7425
Practice Address - Fax:256-325-2465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-10
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529922830Medicaid
ALK266Medicare ID - Type UnspecifiedMEDICARE