Organization
WVP MEDICAL GROUP, LLC
Active
Parent organization
MID VALLEY IPA INC.
Other names
WVP Mission Street Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
MID VALLEY IPA INC.
Authorized official
MR. DEAN G ANDRETTA (CFO)
(503) 371-7701
Entity
Organization
Contact information
Practice address
1155 MISSION ST SE, SUITE 205, SALEM, OR 97302-6228
(503) 362-6304
(503) 362-5570
Mailing address
1155 MISSION ST SE, SUITE 205, SALEM, OR 97302-6228
(503) 362-6304
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
OR
Other
Enumeration date
05/01/2012
Last updated
03/18/2014
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