Provider Demographics
NPI:1841372240
Name:VALLEY FAMILY HEALTH CENTER MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:VALLEY FAMILY HEALTH CENTER MEDICAL GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:559-867-4416
Mailing Address - Street 1:PO BOX 543
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93656-0543
Mailing Address - Country:US
Mailing Address - Phone:559-867-4416
Mailing Address - Fax:559-867-3010
Practice Address - Street 1:3567 W MT WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:CA
Practice Address - Zip Code:93656
Practice Address - Country:US
Practice Address - Phone:559-867-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ22872ZMedicare ID - Type Unspecified
CAZZZ22874ZMedicare ID - Type Unspecified
CAZZZ22875ZMedicare ID - Type Unspecified
CAZZZ22873ZMedicare ID - Type Unspecified
CAZZZ22881ZMedicare ID - Type Unspecified
CAZZZ22878ZMedicare ID - Type Unspecified
CAZZZ22877ZMedicare ID - Type Unspecified
CAZZZ22880ZMedicare ID - Type Unspecified
CAZZZ22876ZMedicare ID - Type Unspecified
CAZZZ9062ZMedicare ID - Type Unspecified
CAZZZ22879ZMedicare ID - Type Unspecified