Provider Demographics
NPI:1639148778
Name:VALLEY HEALTH CARE, INC.
Entity Type:Organization
Organization Name:VALLEY HEALTH CARE, INC.
Other - Org Name:FAMILY PRACTICE COMMUNITY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:G.
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HINCHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:304-335-2050
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:26280-0247
Mailing Address - Country:US
Mailing Address - Phone:304-335-2050
Mailing Address - Fax:304-335-6158
Practice Address - Street 1:GORMAN AVE. AND 8TH ST.
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3394
Practice Address - Country:US
Practice Address - Phone:304-335-2050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV420005OtherVACCINE FOR CHILDREN
WV5657280002OtherHEALTH NOW DMERC/FQHC
WV000394653OtherBC/BS MEDICARE FQHC
WV51D1051732OtherCLIA
WV3810006663Medicaid
WVCH3574OtherRAILROAD MEDICARE
WV05-5-00344OtherWV STATE TAX BUS. LIC
WV1025217OtherBRICKSTREET WORKERS COMP
WVCH3574OtherRAILROAD MEDICARE
WV511906Medicare PIN