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General NPI Number Information
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NPI Number | 1326304577
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Entity Type | Organization
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Legal Business Name | MIDV-VALLEY HEALTHCARE, INC.
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Dates
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Enumeration Date | 04/02/2012
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Last Update Date | 04/02/2012
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Provider Practice Location Address
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Address Line | 701 N 5TH ST SUITE C-1020
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City | LEBANON
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State | OR
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Zip | 97355-9559
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Country | US
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Telephone | 541-451-7820
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Fax |
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Provider Business Mailing Address
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Address Line | 701 N 5TH ST SUITE C-1020
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City | LEBANON
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State | OR
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Zip | 97355-9559
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Country | US
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Telephone | 541-451-7820
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BECKY A PAPE
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Credential |
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Telephone | 541-451-7107
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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