Provider Demographics
NPI:1154618312
Name:SHENANDOAH VALLEY GASTROENTEROLOGY CENTER, PLLC
Entity type:Organization
Organization Name:SHENANDOAH VALLEY GASTROENTEROLOGY CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:POU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-246-5515
Mailing Address - Street 1:PO BOX 85
Mailing Address - Street 2:
Mailing Address - City:PENN LAIRD
Mailing Address - State:VA
Mailing Address - Zip Code:22846-0085
Mailing Address - Country:US
Mailing Address - Phone:540-246-5515
Mailing Address - Fax:
Practice Address - Street 1:1305 13TH ST
Practice Address - Street 2:SUITE A-2
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-3631
Practice Address - Country:US
Practice Address - Phone:540-246-5515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-07
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234913207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty