NPIMap

Organization Active NPI

La Clinica del Valle Family Health Care Center Inc.

  • Federally Qualified Health Center (FQHC)
  • Medford, OR
National Provider Identifier
1073100202
Registry record updated May 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LA CLINICA DEL VALLE FAMILY HEALTH CARE CENTER INC.
Practice address
638 Market St
Medford, OR 97504-6126
Phone
(541) 494-3840
Fax
(541) 494-1789
NPI assigned
Dec 22, 2020
Organization subpart
Yes
Parent organization
LA CLINICA DEL VALLE FAMILY HEALTH CARE CENTER INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 31, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tara Lynette Jeannot
Title
Coo
Phone
(541) 535-6239

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

638 Market St
Medford, OR 97504-6126

Mailing address

931 Chevy Way
Medford, OR 97504-4127
Phone (541) 690-3555

Other identifiers 1

IdentifierTypeStateIssuer
022868MedicaidOR

Other names 1

  • La Clinica Acute Care Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
La Clinica del Valle Family Health Care Center Inc33 organizations share this tax ID, including this one
Part of
La Clinica del Valle Family Health Care Center Inc

Other organizations with this tax ID 32

Organizations that report the same tax identification number in the National Provider Directory.

View all 32

Locations

616 Market St
Medford, OR 97504
Phone (541) 494-3840

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1608595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717113600000",
    "number": "1073100202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "931 CHEVY WAY",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975044127",
            "telephone_number": "541-690-3555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "638 MARKET ST",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975046126",
            "telephone_number": "541-494-3840",
            "fax_number": "541-494-1789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA CLINICA DEL VALLE FAMILY HEALTH CARE CENTER INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LA CLINICA DEL VALLE FAMILY HEALTH CARE CENTER INC.",
        "enumeration_date": "2020-12-22",
        "last_updated": "2024-05-31",
        "certification_date": "2024-05-31",
        "status": "A",
        "authorized_official_last_name": "JEANNOT",
        "authorized_official_first_name": "TARA",
        "authorized_official_middle_name": "LYNETTE",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "541-535-6239"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "022868",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "La Clinica Acute Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "La Clinica Acute Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Medford, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.