Mid-Valley Healthcare, Inc
Organization Active NPI Nephrology Physician · Lebanon, OR
NPI 1366701344 · NPPES record last updated May 10, 2012
Key facts
- NPI
- 1366701344
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Nephrology Physician 207RN0300X
- Legal business name
- MID-VALLEY HEALTHCARE, INC
- Practice address
- 100 Mullins Dr
Suite B1
Lebanon, OR 97355-3982 - Phone
- (541) 768-6930
- NPI assigned
- May 10, 2012
- Organization subpart
- No
Authorized official
- Name
- Becky Pape
- Title
- Ceo
- Phone
- (541) 451-7107
Other NPIs on the same Medicare enrollment 27
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031111000297 | OR | Part B Supplier - Clinic/Group Practice | 2769391523 |
Receives reassigned benefits from 458 practitioners 27 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Lebanon, OR; Sweet Home, OR; Newport, OR; Halsey, OR; Brownsville, OR |
National Provider Directory
Locations
100 Mullins Dr
Ste B1
Lebanon, OR 97355
Phone (541) 768-5810
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician |
207RN0300X | Yes |
Addresses
Primary practice location
100 Mullins Dr
Suite B1
Lebanon, OR 97355-3982
Mailing address
100 Mullins Dr
Suite B1
Lebanon, OR 97355-3982
Phone (541) 768-6930
Other names
- Samaritan Kidney Specialists
NPI Registry JSON
{
"created_epoch": "1336608000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1336608000000",
"number": "1366701344",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 MULLINS DR",
"address_2": "SUITE B1",
"city": "LEBANON",
"state": "OR",
"postal_code": "973553982",
"telephone_number": "541-768-6930"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 MULLINS DR",
"address_2": "SUITE B1",
"city": "LEBANON",
"state": "OR",
"postal_code": "973553982",
"telephone_number": "541-768-6930"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MID-VALLEY HEALTHCARE, INC",
"organizational_subpart": "NO",
"enumeration_date": "2012-05-10",
"last_updated": "2012-05-10",
"status": "A",
"authorized_official_last_name": "PAPE",
"authorized_official_first_name": "BECKY",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "541-451-7107"
},
"taxonomies": [
{
"code": "207RN0300X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine, Nephrology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Samaritan Kidney Specialists",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Lebanon, OR
- Mid Valley Healthcare Inc
- Mid-Valley Healthcare Inc
- Mid-Valley Healthcare Inc
- Mid-Valley Healthcare Inc
- Mid-Valley Healthcare Inc
- Mid-Valley Healthcare, Inc.
- Mid-Valley Healthcare, Inc.
- Mid-Valley Healthcare, Inc.
- Mid-Valley Healthcare, Inc.
- Mid-Valley Healthcare, Inc.
All providers in Lebanon, OR · Nephrology Physician in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 10, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.