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General NPI Number Information
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NPI Number | 1528334125
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Entity Type | Organization
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Legal Business Name | MID-VALLEY HEALTHCARE, INC.
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Dates
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Enumeration Date | 03/28/2012
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 1289 49TH AVE STE 102
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City | SWEET HOME
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State | OR
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Zip | 97386-3230
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Country | US
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Telephone | 541-451-6250
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1189
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City | CORVALLIS
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State | OR
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Zip | 97339-1189
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Country | US
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Telephone | 541-768-4410
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Fax |
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Authorized Official
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Title or Position | CEO-SLCH
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Name | DR. DANIEL RACKHAM
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Credential |
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Telephone | 541-768-6768
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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