MEDICARE: VALLEY PLASTIC SURGERY PC

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	174400000X	Specialist	0101056247	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	289222	OTHER	VA	ANTHEM GRP PROV NUMBER

General Provider Information

NPI Number	:	1255432076
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY PLASTIC SURGERY PC

Provider Business Mailing Address
First Line	:	2058 PRO POINTE LN
Second Line	:
City	:	HARRISONBURG
State	:	VA
Zip	:	22801-8021
Country	:	US
Telephone Number	:	540-438-0600
Fax Number	:	540-438-0800

Provider Business Practice Location Address
First Line	:	2058 PRO POINTE LN
Second Line	:
City	:	HARRISONBURG
State	:	VA
Zip	:	22801-8021
Country	:	US
Telephone Number	:	540-438-0600
Fax Number	:	540-438-0800

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. TIMOTHY J BILL
Credential	:	MD
Telephone Number	:	540-438-0600

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	06/03/2011

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