Basic Information
| Provider Information | |||||||||
| NPI: | 1780675538 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VALLEY REGIONAL MEDICAL SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | VALLEY REGIONAL MEDICAL SERVICES | ||||||||
| Address2: | P.O. BOX | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022410001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786870156 | ||||||||
| FaxNumber: | 9789890019 | ||||||||
| Practice Location | |||||||||
| Address1: | VALLEY REGIONAL MEDICAL SERVICES | ||||||||
| Address2: | 70 EAST ST. | ||||||||
| City: | METHUEN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022414060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786870156 | ||||||||
| FaxNumber: | 9789890019 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | FERRITER | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9786870156 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 9779086 | 05 | MA | MEDICAID |