Provider Demographics
NPI:1922237874
Name:UPPER VALLEY FAMILY PRACTICE, PLLC
Entity Type:Organization
Organization Name:UPPER VALLEY FAMILY PRACTICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHYSICAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:G
Authorized Official - Last Name:HOPKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-356-8883
Mailing Address - Street 1:32 W 1ST S
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-1810
Mailing Address - Country:US
Mailing Address - Phone:208-356-8883
Mailing Address - Fax:208-656-0292
Practice Address - Street 1:32 W 1ST S
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-1810
Practice Address - Country:US
Practice Address - Phone:208-356-8883
Practice Address - Fax:208-656-0292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-13
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-6910207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID003727500Medicaid
ID003727500Medicaid