Provider Demographics
NPI:1578665691
Name:VALLEY REGIONAL MEDICAL SVS.
Entity type:Organization
Organization Name:VALLEY REGIONAL MEDICAL SVS.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT CHIEF OPERATI
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCDRURY
Authorized Official - Suffix:
Authorized Official - Credentials:SVP COO
Authorized Official - Phone:978-687-0156
Mailing Address - Street 1:PO BOX 71
Mailing Address - Street 2:C/O KDC MANAGEMENT
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-0071
Mailing Address - Country:US
Mailing Address - Phone:978-657-5866
Mailing Address - Fax:978-657-5877
Practice Address - Street 1:60 EAST ST
Practice Address - Street 2:SUITE 3300
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-4500
Practice Address - Country:US
Practice Address - Phone:978-685-9440
Practice Address - Fax:978-686-3093
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALLEY REGIONAL MEDICAL SERVICES CORP.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-01
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA49865207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0029641OtherNEIGHBORHOOD HEALTH PLAN
NH01Y005533MA01OtherANTHEM
MA51762OtherFALLON
MA978403OtherNETWORK
NH30008466OtherMEDICAID OF NH
MA611003OtherTUFTS
MAM17489OtherBC/BS GROUP NUMBER
MA2441758OtherAETNA
MA9787143Medicaid
MAM17489OtherBC/BS GROUP NUMBER
MA978403OtherNETWORK
MAM20792Medicare ID - Type UnspecifiedGROUP NUMBER