Healthcare Provider Details

I. General information

NPI: 1972792489
Provider Name (Legal Business Name): UPPER VALLEY COMMUNITY HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2007
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 E MAIN ST STE 1
SAINT ANTHONY ID
83445-1546
US

IV. Provider business mailing address

PO BOX 18
SAINT ANTHONY ID
83445-0018
US

V. Phone/Fax

Practice location:
  • Phone: 208-356-4900
  • Fax: 208-624-4116
Mailing address:
  • Phone: 208-356-4900
  • Fax: 208-624-4112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: LORI K SESSIONS
Title or Position: CEO
Credential:
Phone: 208-624-4100