Healthcare Provider Details

I. General information

NPI: 1982694345
Provider Name (Legal Business Name): TREASURE VALLEY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 12/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 SW 3RD AVE SUITE 3200
ONTARIO OR
97914-2193
US

IV. Provider business mailing address

351 SW 9TH ST
ONTARIO OR
97914-2639
US

V. Phone/Fax

Practice location:
  • Phone: 541-881-7370
  • Fax: 541-881-7379
Mailing address:
  • Phone: 541-881-7370
  • Fax: 541-881-7379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StateOR

VIII. Authorized Official

Name: HEATHER LYNN RIVERA
Title or Position: PRACTICE MANAGER
Credential:
Phone: 541-881-7358