Provider Demographics
NPI:1932145109
Name:VALLEY DIGESTIVE CENTER INC
Entity Type:Organization
Organization Name:VALLEY DIGESTIVE CENTER INC
Other - Org Name:VALLEY DIGESTIVE HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF GENERAL PARTNER CORP.
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-665-1283
Mailing Address - Street 1:488 E SANTA CLARA ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-7229
Mailing Address - Country:US
Mailing Address - Phone:626-359-9555
Mailing Address - Fax:626-359-9556
Practice Address - Street 1:488 E SANTA CLARA ST
Practice Address - Street 2:SUITE 102
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-7229
Practice Address - Country:US
Practice Address - Phone:626-359-9555
Practice Address - Fax:626-359-9556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASUR01634FMedicaid
S051634Medicare PIN