Healthcare Provider Details

I. General information

NPI: 1194387647
Provider Name (Legal Business Name): VALLEY PHYSICIAN ENTERPRISE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2019
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 AMHERST ST STE 101
WINCHESTER VA
22601-2808
US

IV. Provider business mailing address

220 CAMPUS BLVD STE 100
WINCHESTER VA
22601-2888
US

V. Phone/Fax

Practice location:
  • Phone: 540-450-0072
  • Fax:
Mailing address:
  • Phone: 540-536-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: RENEE NEVADA JOHNSON
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 540-536-0103