Provider Demographics
NPI:1881830040
Name:VALLEY INTERVENTIONAL PAIN MEDICAL GRP
Entity Type:Organization
Organization Name:VALLEY INTERVENTIONAL PAIN MEDICAL GRP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-571-1693
Mailing Address - Street 1:1524 MCHENRY AVE.
Mailing Address - Street 2:#445
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350
Mailing Address - Country:US
Mailing Address - Phone:209-571-1693
Mailing Address - Fax:209-571-0326
Practice Address - Street 1:1524 MCHENRY AVE
Practice Address - Street 2:#445
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350
Practice Address - Country:US
Practice Address - Phone:209-571-1693
Practice Address - Fax:209-571-0326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-18
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05D1086032291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D1086032OtherCLIA STATE OF CA