Basic Information
| Provider Information | |||||||||
| NPI: | 1649250309 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VALLEY HEALTH SYSTEMS INC | ||||||||
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| OtherOrganizationName: | VALLEY HEALTH HARTS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1680 | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257171680 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 22 FLEMING DR | ||||||||
| Address2: | |||||||||
| City: | HARTS | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3048554595 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2006 | ||||||||
| LastUpdateDate: | 03/31/2022 | ||||||||
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| AuthorizedOfficialLastName: | BRUBECK | ||||||||
| AuthorizedOfficialFirstName: | MARY-BETH | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT OF FINANCE / CFO | ||||||||
| AuthorizedOfficialTelephone: | 3045253334 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 15818 | WV | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207V00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 261QF0400X | WV | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | CJ2698 | 01 | WV | RR MEDICARE GROUP | OTHER | 0035079000 | 05 | WV | MEDICAID | 614938701 | 01 | WV | BLACK LUNG | OTHER |