Provider Demographics
NPI:1831194265
Name:THE VALLEY CLINIC LLP
Entity type:Organization
Organization Name:THE VALLEY CLINIC LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:NIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-925-3151
Mailing Address - Street 1:716 E MANITOBA AVE
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-3842
Mailing Address - Country:US
Mailing Address - Phone:509-925-3151
Mailing Address - Fax:
Practice Address - Street 1:716 E MANITOBA AVE
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3842
Practice Address - Country:US
Practice Address - Phone:509-925-3151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2520916959174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7831308Medicaid
WA7831308Medicaid
WAF37497Medicare UPIN
WAP55781Medicare UPIN
WAA07968Medicare UPIN
WAP54495Medicare UPIN
WAE67945Medicare UPIN
WA69411Medicare ID - Type UnspecifiedBECKETT
WAA07971Medicare UPIN
WAAB02968Medicare ID - Type UnspecifiedLARSON
WAF48818Medicare UPIN
WAAB28255Medicare ID - Type UnspecifiedK. LARSON
WAP54494Medicare UPIN
WAE17465Medicare UPIN