Healthcare Provider Details

I. General information

NPI: 1609814219
Provider Name (Legal Business Name): VALLEY HEALTHCARE SYSTEM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 07/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 FORT BENNING ROAD
COLUMBUS GA
31903-2407
US

IV. Provider business mailing address

1600 FORT BENNING ROAD
COLUMBUS GA
31903-2407
US

V. Phone/Fax

Practice location:
  • Phone: 706-322-9599
  • Fax: 706-322-9567
Mailing address:
  • Phone: 706-322-9599
  • Fax: 706-322-9567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SARAH E LANG
Title or Position: CEO
Credential:
Phone: 706-322-9599