MEDICARE: VALLEY HEALTHCARE 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	3336C0003X	Community/Retail Pharmacy
2	261QF0400X	Federally Qualified Health Center (FQHC)

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	202G702049	OTHER	GA	MEDICARE PTAN

Other Identifiers

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

General Provider Information

NPI Number	:	1609814219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY HEALTHCARE SYSTEM INC

Provider Business Mailing Address
First Line	:	1600 FORT BENNING ROAD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31903-2407
Country	:	US
Telephone Number	:	706-322-9599
Fax Number	:	706-322-9567

Provider Business Practice Location Address
First Line	:	1600 FORT BENNING ROAD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31903-2407
Country	:	US
Telephone Number	:	706-322-9599
Fax Number	:	706-322-9567

Authorized Official
Title or Position	:	CEO
Name	:	SARAH E LANG
Credential	:
Telephone Number	:	706-322-9599

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	07/03/2018

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Directions to “VALLEY HEALTHCARE SYSTEM INC ” Practice Location

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