Healthcare Provider Details

I. General information

NPI: 1881893550
Provider Name (Legal Business Name): SHENANDOAH VALLEY FAMILY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 HOVATER DRIVE
INWOOD WV
25428
US

IV. Provider business mailing address

PO BOX 1146
MARTINSBURG WV
25402-1146
US

V. Phone/Fax

Practice location:
  • Phone: 304-263-4999
  • Fax: 304-263-0984
Mailing address:
  • Phone: 304-263-4999
  • Fax: 304-263-0984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine 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: DAVID FANT
Title or Position: CEO
Credential:
Phone: 304-263-4999