Organization
WVP MEDICAL GROUP, LLC
Active
Parent organization
MID VALLEY IPA INC. (WVP HEALTH AUTHORITY)
Organization subpart
Yes
Provider details
NPI number
Legal business name
MID VALLEY IPA INC. (WVP HEALTH AUTHORITY)
Authorized official
MR. DEAN G. ANDRETTA (CFO)
(503) 371-7701
Entity
Organization
Contact information
Practice address
2485 12TH ST SE, SALEM, OR 97302-2151
(503) 363-8047
(503) 363-6571
Mailing address
2995 RYAN DR SE, STE. 200, SALEM, OR 97301-5157
(503) 371-7701
Taxonomy
Speciality
Code
Description
License number
State
207QB0002X
Obesity Medicine (Family Medicine) Physician
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
288533
—
OR
01
—
R151720
PTAN
OR
Enumeration date
09/29/2009
Last updated
04/19/2018
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