Provider Demographics
NPI:1245244243
Name:SHENANDOAH VALLEY SURG ASSOC INC
Entity Type:Organization
Organization Name:SHENANDOAH VALLEY SURG ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:FAULKENBERRY
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:540-332-5999
Mailing Address - Street 1:70 MEDICAL CENTER CIR
Mailing Address - Street 2:STE 213
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-2273
Mailing Address - Country:US
Mailing Address - Phone:540-332-5999
Mailing Address - Fax:540-332-5990
Practice Address - Street 1:70 MEDICAL CENTER CIR
Practice Address - Street 2:STE 213
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2273
Practice Address - Country:US
Practice Address - Phone:540-332-5999
Practice Address - Fax:540-332-5990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC00451Medicare ID - Type Unspecified