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NPI Code Detail

MEDICARE: VALLEY FAMILY HEALTH CARE INC

MEDICARE: VALLEY FAMILY HEALTH CARE 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
1207Q00000XFamily Medicine Physician
2261QM1300XMulti-Specialty Clinic/Center
3261QF0400XFederally Qualified Health Center (FQHC)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1002549000OTHERIDHEALTHY CONNECTIONS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3FQHCOTHERIDCOMMUNITY HEALTH CENTER
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1407886484
Entity Type Code : Organization
Provider Name (Legal Business Name) : VALLEY FAMILY HEALTH CARE INC
Provider Business Mailing Address
First Line : 1441 NE 10TH AVE
Second Line :
City : PAYETTE
State : ID
Zip : 83661-5420
Country : US
Telephone Number : 208-642-9376
Fax Number : 208-642-9598
Provider Business Practice Location Address
First Line : 1441 NE 10TH AVE
Second Line :
City : PAYETTE
State : ID
Zip : 83661-5420
Country : US
Telephone Number : 208-642-9376
Fax Number : 208-642-9598
Authorized Official
Title or Position : CEO
Name : KENNETH ROBERT HART
Credential :
Telephone Number : 208-642-7364
Provider Enumeration Date : 07/04/2006
Last Update Date : 02/01/2024

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Directions to “VALLEY FAMILY HEALTH CARE INC ” Practice Location

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