Basic Information
| Provider Information | |||||||||
| NPI: | 1891202412 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VALLEY PHYSICIAN ENTERPRISE, INC. | ||||||||
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| OtherOrganizationName: | GENERAL SURGERY SPECIALISTS PLC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 CAMPUS BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226012889 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405360231 | ||||||||
| FaxNumber: | 5405360235 | ||||||||
| Practice Location | |||||||||
| Address1: | 1870 AMHERST ST STE 2A | ||||||||
| Address2: | |||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226012841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5407223595 | ||||||||
| FaxNumber: | 5406673068 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2018 | ||||||||
| LastUpdateDate: | 01/04/2018 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | RENEE | ||||||||
| AuthorizedOfficialMiddleName: | NEVADA | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 5405360103 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | VA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.