Provider Demographics
NPI:1912065863
Name:VALLEY HEALTH CLINIC INC
Entity Type:Organization
Organization Name:VALLEY HEALTH CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABDULLAH
Authorized Official - Middle Name:AL
Authorized Official - Last Name:FAROOQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-393-8883
Mailing Address - Street 1:PO BOX 27
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20167-0027
Mailing Address - Country:US
Mailing Address - Phone:703-393-8883
Mailing Address - Fax:703-686-4240
Practice Address - Street 1:8609 SUDLEY RD
Practice Address - Street 2:SUITE 105
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4500
Practice Address - Country:US
Practice Address - Phone:703-393-8883
Practice Address - Fax:703-686-4240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101227765174400000X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005867568Medicaid
VA1912065863Medicaid
VAH32516Medicare UPIN