Healthcare Provider Details

I. General information

NPI: 1699537571
Provider Name (Legal Business Name): UPPER VALLEY COMMUNITY HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2024
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2454 N 25TH E STE 103
IDAHO FALLS ID
83401-1050
US

IV. Provider business mailing address

PO BOX 18
SAINT ANTHONY ID
83445-0018
US

V. Phone/Fax

Practice location:
  • Phone: 208-612-6300
  • Fax: 208-612-6119
Mailing address:
  • Phone: 208-356-4900
  • Fax: 208-624-4112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LORI K SESSIONS
Title or Position: CEO
Credential:
Phone: 208-356-4900