Provider Demographics
NPI:1558735209
Name:APPLE VALLEY FAMILY MEDICINE AND URGENT CARE
Entity Type:Organization
Organization Name:APPLE VALLEY FAMILY MEDICINE AND URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KOLAWALE
Authorized Official - Middle Name:ADEDEJI
Authorized Official - Last Name:OSHIYOYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-476-0791
Mailing Address - Street 1:202 FOXCROFT AVENUE
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401
Mailing Address - Country:US
Mailing Address - Phone:240-476-0791
Mailing Address - Fax:
Practice Address - Street 1:202 FOXCROFT AVE
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-5312
Practice Address - Country:US
Practice Address - Phone:240-476-0791
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-18
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV25370207Q00000X
261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1427362383OtherNPI
WV3364BMedicare UPIN