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General NPI Number Information
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NPI Number | 1881893550
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Entity Type | Organization
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Legal Business Name | SHENANDOAH VALLEY FAMILY HEALTH CENTER
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Dates
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Enumeration Date | 07/13/2007
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Last Update Date | 05/21/2008
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Provider Practice Location Address
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Address Line | 102 HOVATER DRIVE
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City | INWOOD
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State | WV
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Zip | 25428
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Country | US
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Telephone | 304-263-4999
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Fax | 304-263-0984
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Provider Business Mailing Address
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Address Line | PO BOX 1146
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City | MARTINSBURG
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State | WV
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Zip | 25402-1146
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Country | US
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Telephone | 304-263-4999
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Fax | 304-263-0984
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Authorized Official
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Title or Position | CEO
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Name | DAVID FANT
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Credential |
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Telephone | 304-263-4999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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