Healthcare Provider Details

I. General information

NPI: 1447799416
Provider Name (Legal Business Name): VALLEY PHYSICIAN ENTERPRISE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2017
Last Update Date: 02/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W 10TH ST
FRONT ROYAL VA
22630-2807
US

IV. Provider business mailing address

PO BOX 37517
BALTIMORE MD
21297-3517
US

V. Phone/Fax

Practice location:
  • Phone: 540-631-7337
  • Fax: 540-631-2337
Mailing address:
  • Phone: 540-536-7670
  • Fax: 540-536-7682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: RENEE Y BAKER
Title or Position: MANAGER, INSURANCE CREDENITALING
Credential:
Phone: 540-536-0231