Basic Information
| Provider Information | |||||||||
| NPI: | 1477216919 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VALLEY HEALTH SYSTEMS INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | VALLEY HEALTH-WOODRUFF & GONZALES DENTAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1680 | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257171680 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047815159 | ||||||||
| FaxNumber: | 3045238115 | ||||||||
| Practice Location | |||||||||
| Address1: | 1319 HAL GREER BLVD | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257013803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045296060 | ||||||||
| FaxNumber: | 3045296062 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2021 | ||||||||
| LastUpdateDate: | 10/26/2021 | ||||||||
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| AuthorizedOfficialLastName: | BRUBECK | ||||||||
| AuthorizedOfficialFirstName: | MARY-BETH | ||||||||
| AuthorizedOfficialMiddleName: | N. | ||||||||
| AuthorizedOfficialTitleorPosition: | VP OF FINANCE / CFO | ||||||||
| AuthorizedOfficialTelephone: | 3045253334 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | N | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.