Provider Demographics
NPI:1003865122
Name:VALLEY PEDIATRIC GROUP, PLC
Entity Type:Organization
Organization Name:VALLEY PEDIATRIC GROUP, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:HUMPHRIES
Authorized Official - Suffix:
Authorized Official - Credentials:CMM, CPC
Authorized Official - Phone:540-949-5862
Mailing Address - Street 1:108 COMMUNITY DR
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-9505
Mailing Address - Country:US
Mailing Address - Phone:540-949-0118
Mailing Address - Fax:540-932-2059
Practice Address - Street 1:108 COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-9505
Practice Address - Country:US
Practice Address - Phone:540-949-0118
Practice Address - Fax:540-932-2059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty