Provider Demographics
NPI:1114028610
Name:HEALTH VALLEY MEDICAL GROUP INC
Entity Type:Organization
Organization Name:HEALTH VALLEY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER /CEO
Authorized Official - Prefix:
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:THORBUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-925-1000
Mailing Address - Street 1:812 E D ST
Mailing Address - Street 2:
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93245-9545
Mailing Address - Country:US
Mailing Address - Phone:559-925-1000
Mailing Address - Fax:559-925-1084
Practice Address - Street 1:812 E D ST
Practice Address - Street 2:
Practice Address - City:LEMOORE
Practice Address - State:CA
Practice Address - Zip Code:93245-9545
Practice Address - Country:US
Practice Address - Phone:559-925-1000
Practice Address - Fax:559-925-1084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHM53846F207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ00576ZOtherBLUE SHIELD OF CA
CAZZZ00576ZOtherBLUE CROSS OF CALIFORNIA
CAZZZ00576ZOtherMEDICARE NHIC
CARHM53846FMedicaid
CA553846Medicare ID - Type UnspecifiedRURAL HEALTH CLINIC