1730365867 NPI number — MOUNTAIN VALLEY HEALTH SERVICES

Table of content: (NPI 1730365867)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730365867 NPI number — MOUNTAIN VALLEY HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOUNTAIN VALLEY HEALTH SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730365867
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
342 YELLOWSTONE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POCATELLO
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83201-4530
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-479-1996
Provider Business Mailing Address Fax Number:
801-880-4448

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
342 YELLOWSTONE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POCATELLO
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83201-4530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-479-1996
Provider Business Practice Location Address Fax Number:
801-880-4448
Provider Enumeration Date:
01/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PERKINS
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
N
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
801-725-0252

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com