Provider Demographics
NPI:1619949898
Name:VALLEY GASTROENTEROLOGY OF SOUTHWEST VA PC
Entity Type:Organization
Organization Name:VALLEY GASTROENTEROLOGY OF SOUTHWEST VA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CELESTE
Authorized Official - Middle Name:
Authorized Official - Last Name:VINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-776-6300
Mailing Address - Street 1:1906 BRAEBURN DR.
Mailing Address - Street 2:VALLEY GASTROENTEROLOGY OF SOUTHWEST VA PC
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153
Mailing Address - Country:US
Mailing Address - Phone:540-776-6300
Mailing Address - Fax:540-776-1103
Practice Address - Street 1:1906 BRAEBURN DR
Practice Address - Street 2:VALLEY GASTROENTEROLOGY OF SOUTHWEST VA PC
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7304
Practice Address - Country:US
Practice Address - Phone:540-776-6300
Practice Address - Fax:540-776-1103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C05244Medicare PIN