| Ronald F Miciak, MD | |
| 
					801 Pole Line Rd W, Twin Falls, ID 83301-5810  | |
| (208) 814-4100 | |
| (208) 814-4908 | 
| Full Name | Ronald F Miciak | 
|---|---|
| Gender | Male | 
| Speciality | Hospitalist | 
| Location | 801 Pole Line Rd W, Twin Falls, Idaho | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1235179052 | NPI | - | NPPES | 
| P00029390 | Other | ID | RR MEDICARE | 
| 002543700 | Medicaid | ID | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 207R00000X | Internal Medicine | M4130 (Idaho) | Secondary | 
| 208M00000X | Hospitalist | M4130 (Idaho) | Primary | 
| Entity Name | St Lukes Clinic Llc | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1790718229 PECOS PAC ID: 1052217478 Enrollment ID: O20031208000899  | 
| Mailing Address | Practice Location Address | 
|---|---|
| Ronald F Miciak, MD Po Box 587, Twin Falls, ID 83303-0587 Ph: (208) 814-7400  | Ronald F Miciak, MD 801 Pole Line Rd W, Twin Falls, ID 83301-5810 Ph: (208) 814-4100  | 
Kyle Wong, DO Hospitalist Medicare: Accepting Medicare Assignments Practice Location: 801 Pole Line Rd W, Twin Falls, ID 83301 Phone: 208-814-1000  | |
Dr. Sindy Kay Byington, MD Hospitalist Medicare: Accepting Medicare Assignments Practice Location: 801 Pole Line Rd W, Twin Falls, ID 83301 Phone: 406-927-6976  | |
Dr. Thomas Dirocco, M.D. Hospitalist Medicare: Accepting Medicare Assignments Practice Location: 801 Pole Line Rd W, Twin Falls, ID 83301 Phone: 208-814-4100  | |
Bing G Parkinson, MD Hospitalist Medicare: Accepting Medicare Assignments Practice Location: 247 River Vista Pl Ste 101, Twin Falls, ID 83301 Phone: 208-735-2273 Fax: 208-735-2276  |