Provider Demographics
NPI:1861497018
Name:VALLEY MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:VALLEY MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:V
Authorized Official - Last Name:MARRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-732-4269
Mailing Address - Street 1:49 PERSHING DR
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:CT
Mailing Address - Zip Code:06418-1406
Mailing Address - Country:US
Mailing Address - Phone:203-732-4269
Mailing Address - Fax:203-732-4062
Practice Address - Street 1:49 PERSHING DR
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418-1406
Practice Address - Country:US
Practice Address - Phone:203-732-4269
Practice Address - Fax:203-732-4062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT12DME0182CT01OtherANTHEM BLUE CROSS BLUE SH
CTANC1664OtherOXFORD HEALTH
CTBLUECARE FAMILY PLANOther00406954800
CT0167550001Medicare ID - Type Unspecified