MEDICARE: VALLEY HEALTH SYSTEMS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	11577	WV
2	261QF0400X	Federally Qualified Health Center (FQHC)		WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194790022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY HEALTH SYSTEMS INC

Provider Business Mailing Address
First Line	:	PO BOX 1680
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25717-1680
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 PIONEER RD
Second Line	:
City	:	WAYNE
State	:	WV
Zip	:	25570
Country	:	US
Telephone Number	:	304-272-3783
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT OF FINANCE / CFO
Name	:	MARY-BETH BRUBECK
Credential	:
Telephone Number	:	304-525-3334

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	03/31/2022

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Directions to “VALLEY HEALTH SYSTEMS INC ” Practice Location

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