Provider Demographics
NPI:1568486918
Name:CENTRAL VALLEY MEDICAL CENTER
Entity Type:Organization
Organization Name:CENTRAL VALLEY MEDICAL CENTER
Other - Org Name:CENTRAL VALLEY HOME MEDICAL EQUIPMENT & SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAUNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARCHIBALD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:435-623-3060
Mailing Address - Street 1:152 W 1500 N
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEPHI
Mailing Address - State:UT
Mailing Address - Zip Code:84648-9999
Mailing Address - Country:US
Mailing Address - Phone:435-623-3060
Mailing Address - Fax:435-623-3059
Practice Address - Street 1:152 W 1500 N
Practice Address - Street 2:SUITE A
Practice Address - City:NEPHI
Practice Address - State:UT
Practice Address - Zip Code:84648-9999
Practice Address - Country:US
Practice Address - Phone:435-623-3060
Practice Address - Fax:435-623-3059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1184990001332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1184990001Medicare NSC