=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346454337
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEST VALLEY MEDICAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2007
-----------------------------------------------------
Last Update Date | 06/20/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3720 S INDIANA AVE
-----------------------------------------------------
City | CALDWELL
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-459-6041
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16939 DARMADY LOOP
-----------------------------------------------------
City | NAMPA
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83687-9163
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-466-0339
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REHAB SERVICES MANAGER
-----------------------------------------------------
Name | MRS. TAMMY COLVER
-----------------------------------------------------
Credential | O.T.
-----------------------------------------------------
Telephone | 208-459-2476
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 1455
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------