| Midvalley Healthcare | |
|
2321 E Gala St Ste 3 Meridian ID 83642-7692 | |
| (208) 888-5848 | |
| (208) 888-0884 |
| Full Name | Midvalley Healthcare |
|---|---|
| Speciality | Clinic/Center |
| Location | 2321 E Gala St Ste 3, Meridian, Idaho |
| Authorized Official Name and Position | Kristina J Harrington (CO-OWNER) |
| Authorized Official Contact | 2088885848 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Midvalley Healthcare 2321 E Gala St Ste 3 Meridian ID 83642-7692 Ph: (208) 888-5848 | Midvalley Healthcare 2321 E Gala St Ste 3 Meridian ID 83642-7692 Ph: (208) 888-5848 |
| NPI Number | 1346573532 |
|---|---|
| Provider Enumeration Date | 09/07/2009 |
| Last Update Date | 11/16/2021 |
| Certification Date | 11/16/2021 |
| Medicare PECOS PAC ID | 0749327880 |
|---|---|
| Medicare Enrollment ID | O20091022000491 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346573532 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Kristina J Harrington |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1407887623 PECOS PAC ID: 9638069602 Enrollment ID: I20040316000479 |
| Provider Name | Olurotimi A Ashaye |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1649208315 PECOS PAC ID: 0648161356 Enrollment ID: I20040323000336 |
| Provider Name | Toni Sparks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356454839 PECOS PAC ID: 9436124963 Enrollment ID: I20040830000107 |
| Provider Name | Jaiyeola A Ashaye |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952488561 PECOS PAC ID: 6002919404 Enrollment ID: I20070305000540 |
| Provider Name | Donna D Hislop |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972520617 PECOS PAC ID: 2163579152 Enrollment ID: I20090408000463 |
| Provider Name | Cathie D Wick |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497961460 PECOS PAC ID: 5193853034 Enrollment ID: I20100513000306 |
| Provider Name | Shelley Wray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447649975 PECOS PAC ID: 4183943657 Enrollment ID: I20150505000995 |
| Provider Name | Duke M Nyarecha |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235625914 PECOS PAC ID: 6406107093 Enrollment ID: I20180920001736 |
| Provider Name | Gretchen Ruth Gayle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649757279 PECOS PAC ID: 5294074936 Enrollment ID: I20190225002029 |
| Provider Name | Scott A Watkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760950604 PECOS PAC ID: 5698017762 Enrollment ID: I20190422001834 |
| Provider Name | Jeremy Lee Hurst |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275816902 PECOS PAC ID: 6709100944 Enrollment ID: I20200205002148 |
| Provider Name | Gina Froman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669847752 PECOS PAC ID: 6406269026 Enrollment ID: I20201228002146 |
| Provider Name | Misti Newson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295400422 PECOS PAC ID: 9537558564 Enrollment ID: I20211115000026 |
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