Healthcare Provider Details

I. General information

NPI: 1669724928
Provider Name (Legal Business Name): VALLEY REGIONAL ENTERPRISES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2012
Last Update Date: 10/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 ADMINISTRATIVE DR
MARTINSBURG WV
25404-6378
US

IV. Provider business mailing address

97 ADMINISTRATIVE DR
MARTINSBURG WV
25404-6378
US

V. Phone/Fax

Practice location:
  • Phone: 304-350-3200
  • Fax: 304-350-3201
Mailing address:
  • Phone: 304-350-3200
  • Fax: 304-350-3201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number0101057756
License Number StateVA

VIII. Authorized Official

Name: DAVID E WISEMAN
Title or Position: DIVISION CONTROLLER
Credential:
Phone: 540-536-4310