Provider Demographics
NPI:1861562175
Name:GREATER VALLEY MEDICINE
Entity type:Organization
Organization Name:GREATER VALLEY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:LANGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:630-208-3200
Mailing Address - Street 1:2900 FOXFIELD RD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-5799
Mailing Address - Country:US
Mailing Address - Phone:630-208-3200
Mailing Address - Fax:630-208-3203
Practice Address - Street 1:2900 FOXFIELD RD
Practice Address - Street 2:SUITE 307
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-5799
Practice Address - Country:US
Practice Address - Phone:630-208-3200
Practice Address - Fax:630-208-3203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042-007606111NX0800X, 111N00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL702190Medicare PIN
IL365820Medicare PIN