Provider Demographics
NPI:1255432076
Name:VALLEY PLASTIC SURGERY PC
Entity type:Organization
Organization Name:VALLEY PLASTIC SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-438-0600
Mailing Address - Street 1:2058 PRO POINTE LN
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-8021
Mailing Address - Country:US
Mailing Address - Phone:540-438-0600
Mailing Address - Fax:540-438-0800
Practice Address - Street 1:2058 PRO POINTE LN
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-8021
Practice Address - Country:US
Practice Address - Phone:540-438-0600
Practice Address - Fax:540-438-0800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101056247174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA289222OtherANTHEM GRP PROV NUMBER
VA289222OtherANTHEM GRP PROV NUMBER
VAC08749Medicare ID - Type Unspecified