Provider Demographics
NPI:1912185513
Name:VALLEY OBSTETRICS & GYNECOLOGY PC
Entity Type:Organization
Organization Name:VALLEY OBSTETRICS & GYNECOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PRESIDENT VALLEY OBGYN PC
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:CLIFTON
Authorized Official - Last Name:PITMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-233-5000
Mailing Address - Street 1:725 W MARKET ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-2456
Mailing Address - Country:US
Mailing Address - Phone:256-233-5000
Mailing Address - Fax:256-233-5361
Practice Address - Street 1:725 W MARKET ST
Practice Address - Street 2:SUITE B
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-2456
Practice Address - Country:US
Practice Address - Phone:256-233-5000
Practice Address - Fax:256-233-5361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00018174207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529905630Medicaid
AL009937470Medicaid
AL529905630Medicaid
ALF82447Medicare UPIN