Basic Information
Provider Information
NPI: 1508311390
EntityType: 2
ReplacementNPI:  
OrganizationName: VALLEY HEALTH SYSTEMS, INC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
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Credential:  
OtherOrganizationName: VALLEY HEALTH FOODFAIR ROUTE 60
OtherOrganizationType: 3
OtherLastName:  
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OtherCredential:  
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Mailing Information
Address1: 2585 3RD AVE
Address2:  
City: HUNTINGTON
State: WV
PostalCode: 257031642
CountryCode: US
TelephoneNumber: 3046971396
FaxNumber: 3046972086
Practice Location
Address1: 6350 US ROUTE 60 E
Address2:  
City: BARBOURSVILLE
State: WV
PostalCode: 255041232
CountryCode: US
TelephoneNumber: 3043993350
FaxNumber: 3046972086
Other Information
ProviderEnumerationDate: 08/22/2016
LastUpdateDate: 01/09/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: WEINBERGER
AuthorizedOfficialFirstName: RICHARD
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: CFO
AuthorizedOfficialTelephone: 3045253334
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
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AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X  Y193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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