# WVP MEDICAL GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MID VALLEY IPA, INC
- **Other names:** WVP The Doctors Clinic
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1982148789
- **Legal business name:** MID VALLEY IPA, INC
- **Authorized official:** MR. DEAN ANDRETTA (CFO)
- **Authorized official phone:** (503) 371-7701

## Contact information

- **Practice address:** 5050 SKYLINE VILLAGE LOOP S, SALEM, OR 97306-9490
- **Practice address phone:** (503) 391-1110
- **Practice address fax:** (503) 370-4237
- **Mailing address:** 2995 RYAN DR SE STE 200, SALEM, OR 97301-5157
- **Mailing address phone:** (503) 371-7701

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 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