MEDICARE: MID-VALLEY HEALTHCARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154687309
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID-VALLEY HEALTHCARE, INC.

Provider Business Mailing Address
First Line	:	191 N MAIN ST
Second Line	:
City	:	LEBANON
State	:	OR
Zip	:	97355-2870
Country	:	US
Telephone Number	:	541-451-7940
Fax Number	:

Provider Business Practice Location Address
First Line	:	191 N MAIN ST
Second Line	:
City	:	LEBANON
State	:	OR
Zip	:	97355-2870
Country	:	US
Telephone Number	:	541-451-7940
Fax Number	:

Authorized Official
Title or Position	:	CEO - SLCH
Name	:	DANIEL RACKHAM
Credential	:
Telephone Number	:	541-451-7914

Provider Enumeration Date	:	04/02/2012
Last Update Date	:	12/08/2025

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Directions to “MID-VALLEY HEALTHCARE, INC. ” Practice Location

Language	Start Address	Practice Location

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