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	207RA0401X	Addiction Medicine (Internal Medicine) Physician

General Provider Information

NPI Number	:	1740087899
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID-VALLEY HEALTHCARE INC

Provider Business Mailing Address
First Line	:	PO BOX 1189
Second Line	:
City	:	CORVALLIS
State	:	OR
Zip	:	97339-1189
Country	:	US
Telephone Number	:	541-768-4410
Fax Number	:

Provider Business Practice Location Address
First Line	:	5840 NW BIGGS ST STE A
Second Line	:
City	:	NEWPORT
State	:	OR
Zip	:	97365-1157
Country	:	US
Telephone Number	:	541-574-7202
Fax Number	:

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

Provider Enumeration Date	:	02/26/2025
Last Update Date	:	09/18/2025

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Directions to “MID-VALLEY HEALTHCARE INC ” Practice Location

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