NPIMap

Organization Active NPI

Mid-Valley Healthcare, Inc.

Doing business as Samaritan Lebanon Community Pharmacy

  • Community/Retail Pharmacy
  • Lebanon, OR
National Provider Identifier
1699063784
Registry record updated Nov 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
MID-VALLEY HEALTHCARE, INC.
Doing business as
Samaritan Lebanon Community Pharmacy
Practice address
675 N 5TH St
Lebanon, OR 97355-2875
Phone
(541) 451-6410
NPI assigned
Jul 11, 2011
Last updated
Nov 21, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2018

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

Authorized official

Name
Joseph M Cahill
Title
Ceo
Phone
(541) 557-6441

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

675 N 5TH St
Lebanon, OR 97355-2875

Mailing address

675 N 5TH St
Lebanon, OR 97355-2875
Phone (541) 451-7991

Other identifiers 1

IdentifierTypeStateIssuer
IP-0002226-CSOtherOROR BOARD OF PHARMACY

Other names 2

  • Samaritan Lebanon Community Pharmacy Doing business as
  • Samaritan OMT Lebanon Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20160920001328 OR Part B Supplier - Mass Immunization (Roster Biller Only) 2769391523 1 other NPI on this enrollment
Practice locations: Lebanon, OR; Sweet Home, OR
O20180110001367 OR Part B Supplier - Pharmacy 2769391523 2 other NPIs on this enrollment
Practice locations: Lebanon, OR; Sweet Home, OR

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1310342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1542758400000",
    "number": "1699063784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "675 N 5TH ST",
            "city": "LEBANON",
            "state": "OR",
            "postal_code": "973552875",
            "telephone_number": "541-451-7991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 N 5TH ST",
            "city": "LEBANON",
            "state": "OR",
            "postal_code": "973552875",
            "telephone_number": "541-451-6410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-VALLEY HEALTHCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-11",
        "last_updated": "2018-11-21",
        "status": "A",
        "authorized_official_last_name": "CAHILL",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "541-557-6441"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OR BOARD OF PHARMACY",
            "identifier": "IP-0002226-CS",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Samaritan Lebanon Community Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Samaritan OMT Lebanon",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Lebanon, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.