MEDICARE: WEST VALLEY MEDICAL GROUP LLC

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	207R00000X	Internal Medicine Physician

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871673798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST VALLEY MEDICAL GROUP LLC

Provider Business Mailing Address
First Line	:	2000 HEALTH PARK DR
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-4525
Country	:	US
Telephone Number	:	615-373-7600
Fax Number	:	866-346-1426

Provider Business Practice Location Address
First Line	:	1906 FAIRVIEW AVE STE 230
Second Line	:
City	:	CALDWELL
State	:	ID
Zip	:	83605-5432
Country	:	US
Telephone Number	:	208-459-4667
Fax Number	:	208-442-6520

Authorized Official
Title or Position	:	VP
Name	:	LOUIS JOSEPH
Credential	:
Telephone Number	:	615-373-7630

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	01/02/2023

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Directions to “WEST VALLEY MEDICAL GROUP LLC ” Practice Location

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