Healthcare Provider Details

I. General information

NPI: 1164942611
Provider Name (Legal Business Name): MID-VALLEY HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 11/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5234 SW PHILOMATH BLVD STE C
CORVALLIS OR
97333-1042
US

IV. Provider business mailing address

PO BOX 1193
CORVALLIS OR
97339-1193
US

V. Phone/Fax

Practice location:
  • Phone: 541-451-7450
  • Fax: 541-451-7454
Mailing address:
  • Phone: 541-451-7450
  • Fax: 541-451-7454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH M CAHILL
Title or Position: CEO
Credential:
Phone: 541-557-6441