Healthcare Provider Details

I. General information

NPI: 1154697431
Provider Name (Legal Business Name): VALLEY HEALTH SYSTEMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2012
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1246 MCCLELLAN HWY
HARTS WV
25524
US

IV. Provider business mailing address

PO BOX 1680
HUNTINGTON WV
25717-1680
US

V. Phone/Fax

Practice location:
  • Phone: 304-525-3334
  • Fax: 304-697-2086
Mailing address:
  • Phone: 304-525-3334
  • Fax: 304-697-2086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. MARY-BETH BRUBECK
Title or Position: VICE PRESIDENT OF FINANCE / CFO
Credential:
Phone: 304-525-3334