Basic Information
| Provider Information | |||||||||
| NPI: | 1093897852 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VALLEY MEDICAL ASSOCIATES, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3640 MAIN ST | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011071145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137390669 | ||||||||
| FaxNumber: | 4137390621 | ||||||||
| Practice Location | |||||||||
| Address1: | 3640 MAIN ST | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011071145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137390669 | ||||||||
| FaxNumber: | 4137390621 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2006 | ||||||||
| LastUpdateDate: | 07/18/2019 | ||||||||
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| AuthorizedOfficialLastName: | SIRARD | ||||||||
| AuthorizedOfficialFirstName: | CHERYL | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4137390669 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | CG5880 | 01 | MA | RAILROAD MEDICARE | OTHER | 9785868 | 05 | MA | MEDICAID | 5129523 | 01 | MA | AETNA | OTHER | M17342 | 01 | MA | BLUE CROSS | OTHER | 000000008357 | 01 | MA | BMC HEALTHNET | OTHER | 97367701 | 01 | MA | NETWORK HEALTHNET | OTHER | 805184 | 01 | MA | TUFTS | OTHER |