Provider Demographics
NPI:1750096061
Name:INDIAN VALLEY HEALTHCARE LLC
Entity type:Organization
Organization Name:INDIAN VALLEY HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-588-9929
Mailing Address - Street 1:PO BOX 64764
Mailing Address - Street 2:
Mailing Address - City:SOUDERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18964-0764
Mailing Address - Country:US
Mailing Address - Phone:484-588-9929
Mailing Address - Fax:
Practice Address - Street 1:175 STRAFFORD AVE STE 215
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-3317
Practice Address - Country:US
Practice Address - Phone:609-548-3365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-20
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies