Healthcare Provider Details

I. General information

NPI: 1891787222
Provider Name (Legal Business Name): VALLEY INFECTIOUS DISEASE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 ROBESON ST STE 300A
FAYETTEVILLE NC
28301-5520
US

IV. Provider business mailing address

PO BOX 40908
FAYETTEVILLE NC
28309-0908
US

V. Phone/Fax

Practice location:
  • Phone: 910-609-1282
  • Fax: 910-609-1276
Mailing address:
  • Phone: 910-615-6949
  • Fax: 910-615-9761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberH0213
License Number StateNC

VIII. Authorized Official

Name: JOSEPH B FISER
Title or Position: VP MANAGED CARE AND REVENUE CYCLE
Credential:
Phone: 910-615-5572