Provider Demographics
NPI:1528068244
Name:VALACH NEPHROLOGY, HYPERTENSION AND INTERNAL MEDICINE, PA
Entity type:Organization
Organization Name:VALACH NEPHROLOGY, HYPERTENSION AND INTERNAL MEDICINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEPHROLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:PESEK
Authorized Official - Last Name:VALACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-508-5010
Mailing Address - Street 1:1409 HIGHWAY 201 N
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-2425
Mailing Address - Country:US
Mailing Address - Phone:870-508-5010
Mailing Address - Fax:870-508-5020
Practice Address - Street 1:1409 HIGHWAY 201 N
Practice Address - Street 2:SUITE 1
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2425
Practice Address - Country:US
Practice Address - Phone:870-508-5010
Practice Address - Fax:870-508-5020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16660207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C747OtherARKANSAS BLUE CROSS BLUE SHIELD
AR149116002Medicaid
========= 72653OtherTRICARE
========= 72653OtherTRICARE
AR5C747Medicare PIN