Healthcare Provider Details

I. General information

NPI: 1134170822
Provider Name (Legal Business Name): VALLEY HYPERTENSION-NEPHROLOGY ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 11/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

937 GREGORY DR
ROANOKE RAPIDS NC
27870
US

IV. Provider business mailing address

PO BOX 220
ROANOKE RAPIDS NC
27870-0220
US

V. Phone/Fax

Practice location:
  • Phone: 252-535-2111
  • Fax: 252-535-1295
Mailing address:
  • Phone: 252-535-2111
  • Fax: 252-535-1295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier890265V
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 2
Identifier0265V
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerBCBS NC

VIII. Authorized Official

Name: MRS. IMELDA B BERNARDO
Title or Position: OFFICE MANAGER
Credential:
Phone: 252-535-2111