Provider Demographics
NPI:1275838807
Name:VALLEY REGIONAL ENTERPRISES, INC.
Entity Type:Organization
Organization Name:VALLEY REGIONAL ENTERPRISES, INC.
Other - Org Name:OCCUPATIONAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIVISION CONTROLLER
Authorized Official - Prefix:
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 24189
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-0689
Mailing Address - Country:US
Mailing Address - Phone:410-487-8668
Mailing Address - Fax:540-850-4264
Practice Address - Street 1:120 N COMMERCE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-2660
Practice Address - Country:US
Practice Address - Phone:540-536-4883
Practice Address - Fax:540-536-8019
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALLEY REGIONAL ENTERPRISES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine