# MIDVALLEY FAMILY PRACTICE PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568559748
- **Authorized official:** HEATHER BORONSKI (OFFICE MANAGER)
- **Authorized official phone:** (970) 927-4666

## Contact information

- **Practice address:** 1450 E VALLEY RD, SUITE 102, BASALT, CO 81621
- **Practice address phone:** (970) 927-4666
- **Practice address fax:** (970) 927-6623
- **Mailing address:** 1450 E VALLEY RD, SUITE 102, BASALT, CO 81621
- **Mailing address phone:** (970) 927-4666
- **Mailing address fax:** (970) 927-6623

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 124Q00000X | Dental Hygienist | — | NULL | — |
| 124Q00000X | Dental Hygienist | — | — | — |
| 207Q00000X | Family Medicine Physician | 30756 | CO | Yes |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 251S00000X | Community/Behavioral Health Agency | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 10/06/2006
- **Last updated:** 07/07/2020