Provider Demographics
NPI:1316183783
Name:MID VALLEY EMPLOYEES BENEFIT TRUST
Entity Type:Organization
Organization Name:MID VALLEY EMPLOYEES BENEFIT TRUST
Other - Org Name:EBT
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRETTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-587-5107
Mailing Address - Street 1:245 COMMERCIAL ST SE STE 220
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3466
Mailing Address - Country:US
Mailing Address - Phone:503-371-7701
Mailing Address - Fax:503-485-3224
Practice Address - Street 1:245 COMMERCIAL ST SE STE 220
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3466
Practice Address - Country:US
Practice Address - Phone:503-371-7701
Practice Address - Fax:503-485-3224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization