Healthcare Provider Details

I. General information

NPI: 1477105153
Provider Name (Legal Business Name): VALLEY PHYSICIAN ENTERPRISE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2019
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 CAMPUS BLVD STE 410
WINCHESTER VA
22601-2872
US

IV. Provider business mailing address

220 CAMPUS BLVD STE 320
WINCHESTER VA
22601-2889
US

V. Phone/Fax

Practice location:
  • Phone: 540-450-2339
  • Fax: 540-450-2333
Mailing address:
  • Phone: 540-536-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: JILL CHAMBERS
Title or Position: MANAGER INSURANCE CREDENTIALING
Credential:
Phone: 540-536-5100