Provider Demographics
NPI:1861547408
Name:VALLEY MEDICAL INC
Entity type:Organization
Organization Name:VALLEY MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:SORENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:435-528-3598
Mailing Address - Street 1:PO BOX 220655
Mailing Address - Street 2:
Mailing Address - City:CENTERFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84622-0655
Mailing Address - Country:US
Mailing Address - Phone:435-528-3598
Mailing Address - Fax:435-528-5392
Practice Address - Street 1:325 S 300 W
Practice Address - Street 2:
Practice Address - City:CENTERFIELD
Practice Address - State:UT
Practice Address - Zip Code:84622
Practice Address - Country:US
Practice Address - Phone:435-528-3598
Practice Address - Fax:435-528-5392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT22882415901001OtherBLUE CROSS BLUE SHIELD
UT=========OtherTAX ID #
UT22882415901001OtherBLUE CROSS BLUE SHIELD
UT=========000Medicaid