Provider Demographics
NPI:1255842506
Name:VALLEY PHYSICIAN ENTERPRISE, INC
Entity Type:Organization
Organization Name:VALLEY PHYSICIAN ENTERPRISE, INC
Other - Org Name:VALLEY HEALTH WINCHESTER FAMILY PRACTICE RUTHERFORD CROSSING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:NEVADA
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-536-0103
Mailing Address - Street 1:220 CAMPUS BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2889
Mailing Address - Country:US
Mailing Address - Phone:540-536-0231
Mailing Address - Fax:
Practice Address - Street 1:160 MERCHANT STREET
Practice Address - Street 2:STE 100
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22603
Practice Address - Country:US
Practice Address - Phone:540-536-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-13
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty