Provider Demographics
NPI:1225544695
Name:VALLEY IMMEDIATE CARE, LLC
Entity Type:Organization
Organization Name:VALLEY IMMEDIATE CARE, LLC
Other - Org Name:VALLEY IMMEDIATE CARE
Other - Org Type:Other Name
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:541-734-9885
Practice Address - Street 1:235 E BARNETT RD STE 106
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-7903
Practice Address - Country:US
Practice Address - Phone:541-734-9030
Practice Address - Fax:541-734-9885
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALLEY IMMEDIATE CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-21
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19109332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site