1770570004 NPI number — SHENANDOAH VALLEY HEALTH SERVICES LLC

Table of content: (NPI 1770570004)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770570004 NPI number — SHENANDOAH VALLEY HEALTH SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHENANDOAH VALLEY HEALTH SERVICES LLC
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:
6
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:
1770570004
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1910
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINCHESTER
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22604-8060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-536-5229
Provider Business Mailing Address Fax Number:
540-536-4359

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
762 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODSTOCK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22664-1108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-459-2000
Provider Business Practice Location Address Fax Number:
540-459-8540
Provider Enumeration Date:
10/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HEISEY
Authorized Official First Name:
M
Authorized Official Middle Name:
FRANK
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
540-536-5260

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 060972 . This is a "BS TRIGON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1068260 . This is a "WV COMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00239198 . This is a "BS MT STATE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 21638 . This is a "COMMNUITY HEALTH CHN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2122109 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 164072 . This is a "SOUTHERN HEALTH" identifier . This identifiers is of the category "OTHER".




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