Organization
VALLEY MEDICAL CENTER, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID L SCHLACTUS (CEO)
(208) 298-3100
Entity
Organization
Contact information
Practice address
2315 8TH ST, LEWISTON, ID 83501-7301
(208) 746-1383
(208) 746-6348
Mailing address
2315 8TH ST, LEWISTON, ID 83501-7301
(208) 746-1383
(208) 746-6383
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
04-206454
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1942227699
REGENCE BLUESHIELD
ID
05
—
1942227699
—
ID
01
—
31250
LABOR & INDUSTRIES
WA
05
—
7081938
—
WA
01
—
8A950
BLUE CROSS OF ID
ID
Enumeration date
07/17/2006
Last updated
12/12/2016
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