Healthcare Provider Details

I. General information

NPI: 1366212326
Provider Name (Legal Business Name): VALLEY HEALTH SYSTEMS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2024
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 PENNSYLVANIA AVE STE 305
CHARLESTON WV
25302-3390
US

IV. Provider business mailing address

PO BOX 1680
HUNTINGTON WV
25717-1680
US

V. Phone/Fax

Practice location:
  • Phone: 304-982-7031
  • Fax:
Mailing address:
  • Phone: 304-781-5159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MARY-BETH N. BRUBECK
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 304-525-3334