MEDICARE: BI-VALLEY MEDICAL CLINIC, 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	261QM2800X	Methadone Clinic	34-04	CA

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
2	HDC70032F	OTHER	CA	MEDI-CAL

General Provider Information

NPI Number	:	1174544092
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BI-VALLEY MEDICAL CLINIC, INC.

Provider Business Mailing Address
First Line	:	1720 LAKEPOINTE DR STE 117
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75057-6425
Country	:	US
Telephone Number	:	694-704-8784
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 HARRIS AVE
Second Line	:	SUITE A, E, F, G
City	:	SACRAMENTO
State	:	CA
Zip	:	95838-3249
Country	:	US
Telephone Number	:	916-649-6793
Fax Number	:	916-418-0174

Authorized Official
Title or Position	:	VP, TREASURER
Name	:	BRUCE JARVIE
Credential	:
Telephone Number	:	214-379-3300

Provider Enumeration Date	:	07/23/2006
Last Update Date	:	07/29/2024

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