Organization
WVP MEDICAL GROUP, LLC
Active
Parent organization
MID VALLEY IPA, INC
Other names
WVP Independence Monmouth
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
1430 MONMOUTH ST, INDEPENDENCE, OR 97351-1127
(503) 838-1133
(503) 838-5138
Mailing address
2995 RYAN DR SE STE 200, SALEM, OR 97301-5157
(503) 371-7701
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
288533
—
OR
Enumeration date
08/19/2015
Last updated
04/17/2018
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