Provider Demographics
NPI:1669790291
Name:VALLEY ORTHOPEDIC INSTITUTE INC
Entity type:Organization
Organization Name:VALLEY ORTHOPEDIC INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ANAND
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-949-8643
Mailing Address - Street 1:647 W AVENUE Q
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-3893
Mailing Address - Country:US
Mailing Address - Phone:661-949-8643
Mailing Address - Fax:661-947-1361
Practice Address - Street 1:1533 N DOWNS ST
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-2456
Practice Address - Country:US
Practice Address - Phone:760-446-2900
Practice Address - Fax:661-948-2210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-06
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA102466207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABM047AMedicare PIN
CABM052AMedicare PIN
CA6487890002Medicare NSC