Basic Information
| Provider Information | |||||||||
| NPI: | 1639203888 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VALLEY MEDICAL GROUP, P.C. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | VALLEY MEDICAL GROUP AMBULATORY SURGERY & PROCEDURES CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5700 | ||||||||
| Address2: | |||||||||
| City: | BELFAST | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049155700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8664314077 | ||||||||
| FaxNumber: | 4137747448 | ||||||||
| Practice Location | |||||||||
| Address1: | 31 HALL DR | ||||||||
| Address2: | AMHERST MEDICAL CENTER, STE.1 | ||||||||
| City: | AMHERST | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010022751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4132568561 | ||||||||
| FaxNumber: | 4132564321 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2007 | ||||||||
| LastUpdateDate: | 04/30/2021 | ||||||||
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| AuthorizedOfficialLastName: | FEINMAN | ||||||||
| AuthorizedOfficialFirstName: | JOEL | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4137746301 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | VALLEY MEDICAL GROUP, P.C. | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | PH.D. | ||||||||
| NPICertificationDate: | 04/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | 699908 | 01 | MA | TUFTS HEALTH PLAN | OTHER | 3366778 | 01 | MA | AETNA USHEALTHCARE | OTHER | 904268 | 01 | MA | HARVARD PILGRIM HEALTH CA | OTHER | 655416 | 01 | MA | CONNECTICARE, INC. | OTHER | 29488 | 01 | MA | HEALTH NEW ENGLAND | OTHER | M88030 | 01 | MA | BLUE CROSS BLUE SHIELD | OTHER |