Basic Information
| Provider Information | |||||||||
| NPI: | 1528054681 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VALLEY REGIONAL ENTERPRISES INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | VALLEY MEDICAL TRANSPORT | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1910 | ||||||||
| Address2: | |||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226048060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405365229 | ||||||||
| FaxNumber: | 5405364359 | ||||||||
| Practice Location | |||||||||
| Address1: | 295 FRONT ROYAL PIKE | ||||||||
| Address2: | |||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226027319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405362741 | ||||||||
| FaxNumber: | 5407223160 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2005 | ||||||||
| LastUpdateDate: | 07/30/2008 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HEISEY | ||||||||
| AuthorizedOfficialFirstName: | M | ||||||||
| AuthorizedOfficialMiddleName: | FRANK | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5405365260 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 094401 | 01 | BS TRIGO MEDIGAP | OTHER | 000223076 | 01 | BS M T STATE | OTHER | 324118100 | 05 | MD | MEDICAID | 1385406 | 01 | UMWA | OTHER | AM8453410101 | 01 | BS MARYLAND | OTHER | 0144683000 | 05 | WV | MEDICAID | 080196300 | 01 | FED BLACK LUNG | OTHER | 541566064 | 01 | CHIR | OTHER | 0144683001 | 05 | WV | MEDICAID | 2122943 | 01 | MAMSI | OTHER | 9014403 | 05 | VA | MEDICAID |