Village Healthcare of la Grande, Inc.

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

200450130NP Issued in OR

Legal business name

VILLAGE HEALTHCARE OF LA GRANDE, INC.

Doing business as

village healthcare of corvallis

Practice address

656 NW Mirador PL
Corvallis, OR 97330-4698

Phone

(541) 624-2040

Fax

(503) 200-2258

NPI assigned

May 6, 2009

Last updated

Nov 19, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Renee Edwards, FNPNPI 1346241262

Title

Manager Provider President

Phone

(541) 552-0386

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• village healthcare of corvallis Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Renee Edwards, FNP

  • Family Nurse Practitioner
  • Corvallis, OR
  • NPI 1346241262
  Authorized official Same address or phone

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

{
    "created_epoch": "1241568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574121600000",
    "number": "1154555076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "656 NW MIRADOR PL",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973304698",
            "telephone_number": "541-552-0386",
            "fax_number": "503-200-2258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "656 NW MIRADOR PL",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973304698",
            "telephone_number": "541-624-2040",
            "fax_number": "503-200-2258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VILLAGE HEALTHCARE OF LA GRANDE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-06",
        "last_updated": "2019-11-19",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "RENEE",
        "authorized_official_title_or_position": "MANAGER PROVIDER PRESIDENT",
        "authorized_official_telephone_number": "541-552-0386",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "OR",
            "license": "200450130NP",
            "primary": true
        },
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "131713",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "269505",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "village healthcare of corvallis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Isabella Vickers Knight, M.A.
• Thayne Edward Vickstrom
• Dillon Marcus Viescas
• Sridhar Vijayasekaran, MD
• Brett William Villa, DO
• Danielle Monica Villaruz, PT, DPT
• Kate Lousie Villwock
• Vina Moses Welfare Center Inc (Vina Moses Center)
• Lindsay Vinarcsik, MD, PHD
• Nida Visnic

• Clinic/Center in Corvallis, OR
• Providers in Corvallis, OR by specialty
• Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2019; 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.