Provider Demographics
NPI:1063666196
Name:VALLEY REGIONAL ENTERPRISES, INC
Entity Type:Organization
Organization Name:VALLEY REGIONAL ENTERPRISES, INC
Other - Org Name:VALLEY HEALTH QUICK CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:WISEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-536-4310
Mailing Address - Street 1:PO BOX 3548
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22604-2563
Mailing Address - Country:US
Mailing Address - Phone:540-536-2221
Mailing Address - Fax:540-678-4170
Practice Address - Street 1:33820 OLD VALLEY PIKE
Practice Address - Street 2:SUITE 2
Practice Address - City:STRASBURG
Practice Address - State:VA
Practice Address - Zip Code:22657-3793
Practice Address - Country:US
Practice Address - Phone:540-536-2221
Practice Address - Fax:540-678-4170
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALLEY REGIONAL ENTERPRISES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-17
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC10345Medicare Oscar/Certification
VACA5815Medicare Oscar/Certification