Provider Demographics
NPI:1790905859
Name:UMPQUA VALLEY WOMENS CARE PC
Entity Type:Organization
Organization Name:UMPQUA VALLEY WOMENS CARE PC
Other - Org Name:LA BELLA VITA HEALTH & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO/ CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:VANNUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-464-0788
Mailing Address - Street 1:2423 NW TROOST STREET
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470
Mailing Address - Country:US
Mailing Address - Phone:541-464-0788
Mailing Address - Fax:541-464-0789
Practice Address - Street 1:2423 NW TROOST ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-1706
Practice Address - Country:US
Practice Address - Phone:541-464-0788
Practice Address - Fax:541-464-0789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-30
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO21702207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR139406Medicaid
OR067743001OtherBLUE CROSS
OR067743001OtherBLUE CROSS
OR139406Medicaid