Provider Demographics
NPI:1487103917
Name:VALLEY COLORECTAL SURGERY PC
Entity type:Organization
Organization Name:VALLEY COLORECTAL SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ERICH
Authorized Official - Middle Name:W
Authorized Official - Last Name:BRUHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-773-4768
Mailing Address - Street 1:1870 AMHERST ST
Mailing Address - Street 2:SUITE 1-C
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2873
Mailing Address - Country:US
Mailing Address - Phone:540-773-4768
Mailing Address - Fax:540-486-4328
Practice Address - Street 1:1870 AMHERST ST
Practice Address - Street 2:SUITE 1-C
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2873
Practice Address - Country:US
Practice Address - Phone:540-773-4768
Practice Address - Fax:540-486-4328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-26
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101227078208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty