Basic Information
Provider Information | |||||||||
NPI: | 1912196791 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | VALLEY REGIONAL ENTERPRISES, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | VALLEY MEDICAL TRANSPORT | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1910 | ||||||||
Address2: |   | ||||||||
City: | WINCHESTER | ||||||||
State: | VA | ||||||||
PostalCode: | 226048060 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5405364331 | ||||||||
FaxNumber: | 5405362396 | ||||||||
Practice Location | |||||||||
Address1: | 295 FRONT ROYAL PIKE | ||||||||
Address2: |   | ||||||||
City: | WINCHESTER | ||||||||
State: | VA | ||||||||
PostalCode: | 226027325 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5405365422 | ||||||||
FaxNumber: | 5405362396 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/17/2007 | ||||||||
LastUpdateDate: | 07/30/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | HEISEY | ||||||||
AuthorizedOfficialFirstName: | M | ||||||||
AuthorizedOfficialMiddleName: | FRANK | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT, VRE | ||||||||
AuthorizedOfficialTelephone: | 5405365260 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 343900000X | NA | WV | Y |   | Transportation Services | Non-emergency Medical Transport (VAN) |   |
ID Information
ID | Type | State | Issuer | Description | 590011827 | 01 | MD | MEDICARE RAILROAD | OTHER | AM8453410101 | 01 | WV | BS MARYLAND | OTHER | 1385406 | 01 | WV | UMWA | OTHER | 590004610 | 01 | WV | MEDICARE RAILROAD | OTHER |