Provider Demographics
NPI:1891732905
Name:WEST VALLEY MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:WEST VALLEY MEDICAL CENTER, INC.
Other - Org Name:WEST VALLEY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:T
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-455-3720
Mailing Address - Street 1:1717 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-4802
Mailing Address - Country:US
Mailing Address - Phone:208-459-4641
Mailing Address - Fax:208-455-3717
Practice Address - Street 1:1717 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4802
Practice Address - Country:US
Practice Address - Phone:208-459-4641
Practice Address - Fax:208-455-3717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0410091Medicaid
ID131642800OtherDEPT OF LABOR
ID241100Medicaid
AZ027658Medicaid
ID51180OtherBLUE SHIELD
CAXHSP33105Medicaid
AKHS684IPMedicaid
OR026237Medicaid
WA3019882Medicaid
ID00380OtherBLUE CROSS
OR026237Medicaid
CAXHSP33105Medicaid
ID241100Medicaid