Provider Demographics
NPI:1285024497
Name:ALBION VALLEY HEALTH CLINIC INC.
Entity Type:Organization
Organization Name:ALBION VALLEY HEALTH CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:208-312-9740
Mailing Address - Street 1:PO BOX 43
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:ID
Mailing Address - Zip Code:83311-0043
Mailing Address - Country:US
Mailing Address - Phone:208-312-9740
Mailing Address - Fax:208-678-0910
Practice Address - Street 1:400 WEST 5TH STREET
Practice Address - Street 2:
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318
Practice Address - Country:US
Practice Address - Phone:208-312-9740
Practice Address - Fax:208-678-0910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-1514A261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care