Provider Demographics
NPI:1881950038
Name:MID-VALLEY HEALTHCARE, INC.
Entity type:Organization
Organization Name:MID-VALLEY HEALTHCARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WENDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WUNDERWALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-451-7195
Mailing Address - Street 1:PO BOX 1193
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97339-1193
Mailing Address - Country:US
Mailing Address - Phone:541-451-6960
Mailing Address - Fax:
Practice Address - Street 1:425 N SANTIAM HWY
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-4361
Practice Address - Country:US
Practice Address - Phone:541-451-6960
Practice Address - Fax:541-918-5419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500651908Medicaid
OR500651908Medicaid
OR38-1323Medicare PIN