Provider Demographics
NPI:1750785606
Name:VALLEYVIEW FAMILY CARE LLC
Entity type:Organization
Organization Name:VALLEYVIEW FAMILY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SHALAUNDA
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-839-8614
Mailing Address - Street 1:13839 S MUR LEN RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1685
Mailing Address - Country:US
Mailing Address - Phone:913-839-8614
Mailing Address - Fax:913-839-8615
Practice Address - Street 1:13839 S MUR LEN RD
Practice Address - Street 2:SUITE H
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1685
Practice Address - Country:US
Practice Address - Phone:913-839-8614
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-20
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0430824207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS34398046OtherBCBS OF KANSAS
KS200266760HMedicaid
KS130758002Medicare PIN
KSI17455Medicare UPIN