Provider Demographics
NPI:1093733248
Name:JORDAN VALLEY HEALTH CLINIC, INC.
Entity Type:Organization
Organization Name:JORDAN VALLEY HEALTH CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-586-2422
Mailing Address - Street 1:PO BOX 118
Mailing Address - Street 2:
Mailing Address - City:JORDAN VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97910-0118
Mailing Address - Country:US
Mailing Address - Phone:541-586-2422
Mailing Address - Fax:541-586-2419
Practice Address - Street 1:400 IOWA AVE.
Practice Address - Street 2:
Practice Address - City:JORDAN VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97910
Practice Address - Country:US
Practice Address - Phone:541-586-2422
Practice Address - Fax:541-586-2419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD09143363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR383819BMedicare Oscar/Certification