Provider Demographics
NPI:1023217452
Name:SHENANDOAH VALLEY MEDICAL SYSTEM, INC.
Entity Type:Organization
Organization Name:SHENANDOAH VALLEY MEDICAL SYSTEM, INC.
Other - Org Name:WINCHESTER FAMILY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-263-4999
Mailing Address - Street 1:PO BOX 1146
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25402-1146
Mailing Address - Country:US
Mailing Address - Phone:304-263-4999
Mailing Address - Fax:304-263-0984
Practice Address - Street 1:1330 AMHERST ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3054
Practice Address - Country:US
Practice Address - Phone:304-263-4999
Practice Address - Fax:304-263-0984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007604475Medicaid