Basic Information
| Provider Information | |||||||||
| NPI: | 1306074711 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VALLEY LABORATORIES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 545 VALLEY VIEW DR | ||||||||
| Address2: | |||||||||
| City: | MOLINE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 612656138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3097625560 | ||||||||
| FaxNumber: | 3097627351 | ||||||||
| Practice Location | |||||||||
| Address1: | 545 VALLEY VIEW DR | ||||||||
| Address2: | |||||||||
| City: | MOLINE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 612656138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3097625560 | ||||||||
| FaxNumber: | 3097627351 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2009 | ||||||||
| LastUpdateDate: | 01/05/2015 | ||||||||
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| AuthorizedOfficialLastName: | MOVVA | ||||||||
| AuthorizedOfficialFirstName: | RAO | ||||||||
| AuthorizedOfficialMiddleName: | V. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT, CHAIRMAN, AND MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3097625560 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HEARTLAND CLINIC, LLC | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 02729946 | IL | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.