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Organization
WVP MEDICAL GROUP, LLC
Active
Organization
WVP MEDICAL GROUP, LLC
Active
Parent organization
MID VALLEY IPA, INC
Other names
WVP The Doctors Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
MID VALLEY IPA, INC
Authorized official
MR. DEAN ANDRETTA (CFO)
(503) 371-7701
Entity
Organization
Contact information
Practice address
5050 SKYLINE VILLAGE LOOP S, SALEM, OR 97306-9490
(503) 391-1110
(503) 370-4237
Mailing address
2995 RYAN DR SE STE 200, SALEM, OR 97301-5157
(503) 371-7701
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
208600000X
Surgery Physician
—
NULL
208600000X
Surgery Physician
—
—
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
NULL
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
12/13/2016
Last updated
04/17/2018
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