Provider Demographics
NPI:1891732905
Name:WEST VALLEY MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:WEST VALLEY MEDICAL CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:RUCKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-459-4641
Mailing Address - Street 1:1717 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-4802
Mailing Address - Country:US
Mailing Address - Phone:208-459-4641
Mailing Address - Fax:208-455-3717
Practice Address - Street 1:1717 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4802
Practice Address - Country:US
Practice Address - Phone:208-459-4641
Practice Address - Fax:208-455-3717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ027658Medicaid
WA3019882Medicaid
AKHS684IPMedicaid
ID131642800OtherDEPT OF LABOR
ID241100Medicaid
MT0410091Medicaid
OR026237Medicaid
CAXHSP33105Medicaid
ID00380OtherBLUE CROSS
ID51180OtherBLUE SHIELD
OR026237Medicaid
CAXHSP33105Medicaid
ID241100Medicaid