1013951706 NPI number — VALLEY HEALTHCARE SYSTEM INC

Table of content: (NPI 1013951706)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013951706 NPI number — VALLEY HEALTHCARE SYSTEM INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY HEALTHCARE SYSTEM INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013951706
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 FORT BENNING RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31903-2834
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-322-9599
Provider Business Mailing Address Fax Number:
706-322-9567

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
341 N WASHINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TALBOTTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-665-2585
Provider Business Practice Location Address Fax Number:
706-665-2591
Provider Enumeration Date:
06/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LANG
Authorized Official First Name:
SARAH
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
706-322-9599

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 202G702049 . This is a "MEDICARE PTAN" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000617196I , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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