Basic Information
| Provider Information | |||||||||
| NPI: | 1669434502 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VALLEY NEUROLOGICAL SURGERY PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 789 | ||||||||
| Address2: | |||||||||
| City: | LUDLOW | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010560789 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135091000 | ||||||||
| FaxNumber: | 4135091003 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 STAFFORD ST | ||||||||
| Address2: | SUITE 264 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011043581 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4138278800 | ||||||||
| FaxNumber: | 4138278811 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2006 | ||||||||
| LastUpdateDate: | 07/14/2009 | ||||||||
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| AuthorizedOfficialLastName: | KAYE | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4138278800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 71211 | MA | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 3053245 | 05 | MA | MEDICAID | J08850 | 01 | MA | BLUE SHIELD OF MA | OTHER | 751015 | 01 | MA | TUFTS | OTHER | 102900800 | 01 | MA | US DEPT OF LABOR | OTHER | 122410 | 01 | MA | AETNA US HEALTHCARE | OTHER | 98128001 | 01 | MA | NETWORK HEALTH | OTHER | 712110 | 01 | MA | CONNECTICARE | OTHER | 088468683 | 01 | MA | TRICARE | OTHER |