Basic Information
Provider Information | |||||||||
NPI: | 1013528298 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | VALENCE HEALTH CORP PC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | THE MEADOWLARK CLINIC | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1687 | ||||||||
Address2: |   | ||||||||
City: | RAWLINS | ||||||||
State: | WY | ||||||||
PostalCode: | 823011687 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7024533799 | ||||||||
FaxNumber: | 7024535741 | ||||||||
Practice Location | |||||||||
Address1: | 1016 W SPRUCE ST UNIT A | ||||||||
Address2: |   | ||||||||
City: | RAWLINS | ||||||||
State: | WY | ||||||||
PostalCode: | 823015371 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3073285595 | ||||||||
FaxNumber: | 3073285561 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/12/2020 | ||||||||
LastUpdateDate: | 11/06/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | CHIU | ||||||||
AuthorizedOfficialFirstName: | STEPHANIE | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | OWNER / PROVIDER | ||||||||
AuthorizedOfficialTelephone: | 9706902577 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | M.D. | ||||||||
NPICertificationDate: | 11/06/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |   |
No ID Information.