Provider Demographics
NPI:1891220695
Name:VALLEY FAMILY MEDICINE PLLC
Entity Type:Organization
Organization Name:VALLEY FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:KIELER
Authorized Official - Last Name:RICE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:304-901-4197
Mailing Address - Street 1:215 S LOUISIANA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-2023
Mailing Address - Country:US
Mailing Address - Phone:304-901-4197
Mailing Address - Fax:304-699-2943
Practice Address - Street 1:215 S LOUISIANA AVE STE A
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-2023
Practice Address - Country:US
Practice Address - Phone:304-901-4197
Practice Address - Fax:304-699-2943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-29
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21499207Q00000X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
I04351Medicare UPIN