Healthcare Provider Details

I. General information

NPI: 1245244243
Provider Name (Legal Business Name): SHENANDOAH VALLEY SURG ASSOC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 MEDICAL CENTER CIR STE 213
FISHERSVILLE VA
22939-2273
US

IV. Provider business mailing address

70 MEDICAL CENTER CIR STE 213
FISHERSVILLE VA
22939-2273
US

V. Phone/Fax

Practice location:
  • Phone: 540-332-5999
  • Fax: 540-332-5990
Mailing address:
  • Phone: 540-332-5999
  • Fax: 540-332-5990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM L. FAULKENBERRY II
Title or Position: CEO
Credential: M.D.
Phone: 540-332-5999