Provider Demographics
NPI:1750410346
Name:VALLEY AMBULATORY HEALTH CENTER, P.C.
Entity type:Organization
Organization Name:VALLEY AMBULATORY HEALTH CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN, OWNER OF COMPANY
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ECKELS
Authorized Official - Suffix:
Authorized Official - Credentials:DO, FAAFP
Authorized Official - Phone:814-446-5695
Mailing Address - Street 1:PO BOX 486
Mailing Address - Street 2:
Mailing Address - City:SEWARD
Mailing Address - State:PA
Mailing Address - Zip Code:15954-0486
Mailing Address - Country:US
Mailing Address - Phone:814-446-5695
Mailing Address - Fax:
Practice Address - Street 1:238 INDIANA STREET
Practice Address - Street 2:
Practice Address - City:SEWARD
Practice Address - State:PA
Practice Address - Zip Code:15954
Practice Address - Country:US
Practice Address - Phone:814-446-5695
Practice Address - Fax:814-446-4209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-009298-L207Q00000X
PAOS-003436-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015077380001Medicaid
01586199OtherHIGHMARK BLUE CROSS BLUE SHIELD GROUP NUMBER
PA073815OtherECKELS BLUE CROSS BLUE SH
PAP00209792OtherPALMETTO GBA
PA100236OtherECKELS UPMC ID NUMBER
PA255520OtherHEALTH AMERICA GROUP NO.
PA4556169OtherECKELS AETNA NUMBER
PAOS-003436-LOtherECKELS LICENSE NUMBER
B35010OtherECKELS UPIN
PA1014729580001Medicaid
PA613037300OtherFEDERAL BLACK LUNG
PAP00223863OtherPALMETTO GBA
PA073815OtherECKELS BLUE CROSS BLUE SH
PA1014729580001Medicaid