MEDICARE: VALLEY HEALTH SYSTEMS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	103T00000X	Psychologist		WV
3	122300000X	Dentist		WV
4	363A00000X	Physician Assistant		WV
5	207Q00000X	Family Medicine Physician	13536	WV
6	207W00000X	Ophthalmology Physician		WV
7	363LF0000X	Family Nurse Practitioner		WV
8	261QF0400X	Federally Qualified Health Center (FQHC)		WV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CJ2698	OTHER	WV	RR MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	614938700	OTHER	WV	BLACK LUNG
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528038577
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY HEALTH SYSTEMS, INC

Provider Business Mailing Address
First Line	:	2585 3RD AVE
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25703-1642
Country	:	US
Telephone Number	:	304-697-1396
Fax Number	:	304-697-2086

Provider Business Practice Location Address
First Line	:	42 MCGINNIS DR
Second Line	:
City	:	WAYNE
State	:	WV
Zip	:	25570
Country	:	US
Telephone Number	:	304-272-5136
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT OF FINANCE / CFO
Name	:	MARY-BETH BRUBECK
Credential	:
Telephone Number	:	304-525-3334

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	03/31/2022

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Directions to “VALLEY HEALTH SYSTEMS, INC ” Practice Location

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