NPIMap

Organization Active NPI

La Clinica del Valle Family Health Care Center Inc.

  • Federally Qualified Health Center (FQHC)
  • Phoenix, OR
National Provider Identifier
1821333402
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.
Practice address
215 N Rose St
Phoenix, OR 97535
Phone
(541) 535-1065
Fax
(541) 512-2082
NPI assigned
Dec 7, 2012
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 OR Primary

Addresses

Primary practice location

215 N Rose St
Phoenix, OR 97535

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 Phoenix Elementary School Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D2154197La Clinica SBHC at Phoenix Elementary215 N Rose St, Phoenix, OR 97535Certificate of waiverSep 6, 2026

National Provider Directory

National Provider Directory
Tax ID family
La Clinica del Valle Family Health Care Center Inc33 organizations share this tax ID, including this one
Part of
La Clinica del Valle Family Health Care Center Inc

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.

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1354838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563148800000",
    "number": "1821333402",
    "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": "215 N ROSE ST",
            "city": "PHOENIX",
            "state": "OR",
            "postal_code": "97535",
            "telephone_number": "541-535-1065",
            "fax_number": "541-512-2082"
        }
    ],
    "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": "2012-12-07",
        "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": "OR",
            "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 Phoenix Elementary School",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Phoenix, 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.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.