Provider Demographics
NPI: | 1538316203 |
---|---|
Name: | VALLEY PHYSICIAN ENTERPRISE, INC |
Entity Type: | Organization |
Organization Name: | VALLEY PHYSICIAN ENTERPRISE, INC |
Other - Org Name: | |
Other - Org Type: | |
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 100 |
Mailing Address - Street 2: | |
Mailing Address - City: | WINCHESTER |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 22601-2888 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 540-536-5100 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1870 AMHERST ST |
Practice Address - Street 2: | |
Practice Address - City: | WINCHESTER |
Practice Address - State: | VA |
Practice Address - Zip Code: | 22601 |
Practice Address - Country: | US |
Practice Address - Phone: | 540-536-0110 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-08-25 |
Last Update Date: | 2019-12-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 1223S0112X | Dental Providers | Dentist | Oral and Maxillofacial Surgery | Group - Multi-Specialty |
No | 174400000X | Other Service Providers | Specialist | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RC0001X | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | Group - Multi-Specialty |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 207XX0801X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Trauma | Group - Multi-Specialty |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 2084N0600X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Clinical Neurophysiology | Group - Multi-Specialty |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 2086S0129X | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | Group - Multi-Specialty |
No | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
VA | GC1097 | Medicare PIN |