NPIMap

Organization Active NPI

La Clinica del Valle Family Health Care Center Inc.

Doing business as La Clinica School- Based Health Center at Patrick Elementary School

  • Federally Qualified Health Center (FQHC)
  • Gold Hill, OR
National Provider Identifier
1730663790
Registry record updated Jul 15, 2019
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.
Doing business as
La Clinica School- Based Health Center at Patrick Elementary School
Practice address
1500 2ND Ave
Gold Hill, OR 97525-9728
Phone
(541) 494-6818
Fax
(541) 494-6816
NPI assigned
Sep 17, 2018
Last updated
Jul 15, 2019By the provider in NPPES
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 Jul 15, 2019

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

Authorized official

Name
Tara Lynette Jeannot
Title
Chief Operations Officer
Phone
(541) 535-6239

Specialties & licenses 1

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

Addresses

Primary practice location

1500 2ND Ave
Gold Hill, OR 97525-9728

Mailing address

931 Chevy Way
Medford, OR 97504-4127
Phone (541) 535-6239

Other identifiers 1

IdentifierTypeStateIssuer
022868MedicaidOR

Other names 1

  • La Clinica School- Based Health Center at Patrick Elementary School Doing business as

National Provider Directory

National Provider Directory
Tax ID family
La Clinica del Valle Fa33 organizations share this tax ID, including this one
Part of
La Clinica del Valle Fa

Other organizations with this tax ID 32

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

View all 32

Locations

1500 2nd Ave
Gold Hill, OR 97525
Phone (541) 494-6818

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.

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1537142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563148800000",
    "number": "1730663790",
    "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": "541-535-6239",
            "fax_number": "541-842-2212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 2ND AVE",
            "city": "GOLD HILL",
            "state": "OR",
            "postal_code": "975259728",
            "telephone_number": "541-494-6818",
            "fax_number": "541-494-6816"
        }
    ],
    "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": "2018-09-17",
        "last_updated": "2019-07-15",
        "status": "A",
        "authorized_official_last_name": "JEANNOT",
        "authorized_official_first_name": "TARA",
        "authorized_official_middle_name": "LYNETTE",
        "authorized_official_title_or_position": "CHIEF OPERATIONS OFFICER",
        "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 School- Based Health Center at Patrick Elementary School",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gold Hill, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 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.