NPIMap

Organization Active NPI

La Clinica del Valle Family Healthcare Center Inc.

Doing business as Center for Learning and Innovation- La Clinica

  • Federally Qualified Health Center (FQHC)
  • Medford, OR
National Provider Identifier
1205439148
Registry record updated Nov 20, 2020
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 HEALTHCARE CENTER INC.
Doing business as
Center for Learning and Innovation- La Clinica
Practice address
931 Chevy Way
Medford, OR 97504-4127
Phone
(541) 690-3555
Fax
(541) 842-2212
NPI assigned
Nov 20, 2020
Organization subpart
Yes
Parent organization
LA CLINICA DEL VALLE FAMILY HEALTH CARE CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 20, 2020

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

Authorized official

Name
Traci Fossen
Title
Chief Quality Officer
Phone
(541) 512-3912

Specialties & licenses 1

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

Addresses

Primary practice location

931 Chevy Way
Medford, OR 97504-4127

Mailing address

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

Other names 1

  • Center for Learning and Innovation- La Clinica Doing business as

National Provider Directory

National Provider Directory
Tax ID family
La Clinica del Valle Family33 organizations share this tax ID, including this one
Part of
La Clinica del Valle Family

Other organizations with this tax ID 32

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

View all 32

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": "1605830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605830400000",
    "number": "1205439148",
    "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",
            "fax_number": "541-842-2212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "931 CHEVY WAY",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975044127",
            "telephone_number": "541-690-3555",
            "fax_number": "541-842-2212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA CLINICA DEL VALLE FAMILY HEALTHCARE CENTER INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LA CLINICA DEL VALLE FAMILY HEALTH CARE CENTER INC",
        "enumeration_date": "2020-11-20",
        "last_updated": "2020-11-20",
        "certification_date": "2020-11-17",
        "status": "A",
        "authorized_official_last_name": "FOSSEN",
        "authorized_official_first_name": "TRACI",
        "authorized_official_title_or_position": "CHIEF QUALITY OFFICER",
        "authorized_official_telephone_number": "541-512-3912"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Center for Learning and Innovation- La Clinica",
            "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 Nov 20, 2020; 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.