Provider Demographics
NPI:1114678133
Name:VALLEY IMMEDIATE CARE, LLC
Entity Type:Organization
Organization Name:VALLEY IMMEDIATE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:K
Authorized Official - Last Name:DORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-734-9030
Mailing Address - Street 1:815 N CENTRAL AVE STE C
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-5873
Mailing Address - Country:US
Mailing Address - Phone:541-734-9030
Mailing Address - Fax:
Practice Address - Street 1:1217 PLAZA BLVD STE A
Practice Address - Street 2:
Practice Address - City:CENTRAL POINT
Practice Address - State:OR
Practice Address - Zip Code:97502-2682
Practice Address - Country:US
Practice Address - Phone:541-734-9030
Practice Address - Fax:541-734-9885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site