Provider Demographics
NPI:1326322843
Name:UPPER VALLEY FAMILY MEDICINE PLLC
Entity Type:Organization
Organization Name:UPPER VALLEY FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:208-745-5021
Mailing Address - Street 1:2980 N BEVERLY GLEN CIR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1726
Mailing Address - Country:US
Mailing Address - Phone:310-474-9809
Mailing Address - Fax:
Practice Address - Street 1:711 RIGBY LAKE DR
Practice Address - Street 2:SUITE 115
Practice Address - City:RIGBY
Practice Address - State:ID
Practice Address - Zip Code:83442-5192
Practice Address - Country:US
Practice Address - Phone:208-745-5021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UPPER VALLEY FAMILY MEDICINE PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site