MEDICARE: SHENANDOAH VALLEY MEDICAL SYSTEM, 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	261QF0400X	Federally Qualified Health Center (FQHC)

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	:	1508064510
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHENANDOAH VALLEY MEDICAL SYSTEM, INC.

Provider Business Mailing Address
First Line	:	PO BOX 1146
Second Line	:
City	:	MARTINSBURG
State	:	WV
Zip	:	25402-1146
Country	:	US
Telephone Number	:	304-263-4999
Fax Number	:	304-263-0984

Provider Business Practice Location Address
First Line	:	106 SAND MINE RD STE 7
Second Line	:
City	:	BERKELEY SPRINGS
State	:	WV
Zip	:	25411-7457
Country	:	US
Telephone Number	:	304-263-7023
Fax Number	:	304-264-0508

Authorized Official
Title or Position	:	CEO
Name	:	MICHAEL HASSING
Credential	:
Telephone Number	:	304-263-4999

Provider Enumeration Date	:	07/11/2007
Last Update Date	:	07/30/2020

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