Provider Demographics
NPI:1912096082
Name:RADIMECKY, VALEN J (MD)
Entity Type:Individual
Prefix:
First Name:VALEN
Middle Name:J
Last Name:RADIMECKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 99213
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0213
Mailing Address - Country:US
Mailing Address - Phone:682-885-1860
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:4300 W UNIVERSITY DR STE 20
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-9806
Practice Address - Country:US
Practice Address - Phone:682-303-8000
Practice Address - Fax:682-303-8002
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8355208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXRADVB25734OtherCCHIP PIN
TX00U87ZOtherBCBSTX GRP PIN
TX85392XOtherBCBSTX IND PIN
TX140442818Medicaid
1750369203OtherGRP NPI NUMBER
TX2128903OtherCIGNA PIN
TX48329OtherFIRSTHEALTH PIN
TX121977100OtherFIRSTCARE PIN
TX130875104Medicaid
TX4208515OtherAETNA PIN
TX858504OtherUHC PIN
TX140442861Medicaid
TX48329OtherFIRSTHEALTH PIN