LA CLINICA DEL VALLE FAMILY HEALTH CARE CENTER INC NPI 1417372731

NPI Information

NPI: 1417372731
Provider Name: LA CLINICA DEL VALLE FAMILY HEALTH CARE CENTER INC

Doing Business As: BIRCH GROVE HEALTH CENTER- LA CLINICA

Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

Address:
910 S CENTRAL AVE
MEDFORD, OR
ZIP 97501
Phone: (541) 618-1380
Get Directions

LA CLINICA DEL VALLE FAMILY HEALTH CARE CENTER INC is a federally qualified health center (fqhc) clinic center in Medford, OR. LA CLINICA DEL VALLE FAMILY HEALTH CARE CENTER INC NPI is 1417372731. The provider is registered as an organization entity type.
The provider Is Doing Business As Birch Grove Health Center- La Clinica.

The provider's business location address is:

910 S CENTRAL AVE
MEDFORD, OR
ZIP 97501-822
Phone: (541) 618-1380
Fax: (541) 618-1385

The provider's authorized official is Tara Lynette Jeannot .
The authorized official title is Chief Operations Officer and has the following contact phone number (541) 535-6239.

The CLIA number assigned to this NPI record is 38D2154062 - community clinic with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 2/24/2014 and was last updated on 7/15/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	022868	MEDICAID	OREGON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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