Provider Demographics
NPI:1255590188
Name:VALLEY PHYSICIAN ENTERPRISE, INC
Entity type:Organization
Organization Name:VALLEY PHYSICIAN ENTERPRISE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BAMBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COMPHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-636-0289
Mailing Address - Street 1:136 LINDEN DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-6900
Mailing Address - Country:US
Mailing Address - Phone:540-535-0269
Mailing Address - Fax:540-535-0109
Practice Address - Street 1:172 LINDEN DR
Practice Address - Street 2:SUITE 111
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2891
Practice Address - Country:US
Practice Address - Phone:540-535-0269
Practice Address - Fax:540-535-0109
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALLEY PHYSICIAN ENTERPRISE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-05
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014120191223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty