Provider Demographics
NPI:1558471904
Name:VALLEY REGIONAL HOSPITAL
Entity Type:Organization
Organization Name:VALLEY REGIONAL HOSPITAL
Other - Org Name:SULLIVAN COUNTY PARTNERS IN HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PROZZO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:603-543-6960
Mailing Address - Street 1:167 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:NH
Mailing Address - Zip Code:03773-1281
Mailing Address - Country:US
Mailing Address - Phone:603-543-6960
Mailing Address - Fax:603-863-8221
Practice Address - Street 1:167 SUMMER ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NH
Practice Address - Zip Code:03773-1281
Practice Address - Country:US
Practice Address - Phone:603-543-6960
Practice Address - Fax:603-863-8221
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALLEY REGIONAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-30
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0RE3452Medicaid
NH30216262Medicaid
NHNH0647Medicare PIN