Provider Demographics
NPI:1174862304
Name:MID-VALLEY HEALTHCARE, INC.
Entity Type:Organization
Organization Name:MID-VALLEY HEALTHCARE, INC.
Other - Org Name:SAMARITAN UROLOGY-MOORE, LEBANON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-451-7107
Mailing Address - Street 1:100 MULLINS DR
Mailing Address - Street 2:SUITE D-3
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-2868
Mailing Address - Country:US
Mailing Address - Phone:541-812-4388
Mailing Address - Fax:541-812-4393
Practice Address - Street 1:100 MULLINS DR
Practice Address - Street 2:SUITE D-3
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-2868
Practice Address - Country:US
Practice Address - Phone:541-812-4388
Practice Address - Fax:541-812-4393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty