Provider Demographics
NPI:1346454337
Name:WEST VALLEY MEDICAL CENTER
Entity Type:Organization
Organization Name:WEST VALLEY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REHAB SERVICES MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:COLVER
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:208-459-2476
Mailing Address - Street 1:16939 DARMADY LOOP
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-9163
Mailing Address - Country:US
Mailing Address - Phone:208-466-0339
Mailing Address - Fax:
Practice Address - Street 1:3720 S INDIANA AVE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605
Practice Address - Country:US
Practice Address - Phone:208-459-6041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST VALLEY MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-09
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1455282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital