| Mvh Pic Llc | |
|
495 Yellowstone Ave Pocatello ID 83201-4531 | |
| (208) 478-7422 | |
| Not Available |
| Full Name | Mvh Pic Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 495 Yellowstone Ave, Pocatello, Idaho |
| Authorized Official Name and Position | Ned Hillyard (CCO) |
| Authorized Official Contact | 2087094571 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mvh Pic Llc 495 Yellowstone Ave Pocatello ID 83201-4531 Ph: (208) 478-7422 | Mvh Pic Llc 495 Yellowstone Ave Pocatello ID 83201-4531 Ph: (208) 478-7422 |
| NPI Number | 1972035772 |
|---|---|
| Provider Enumeration Date | 03/30/2017 |
| Last Update Date | 04/24/2024 |
| Medicare PECOS PAC ID | 6709156904 |
|---|---|
| Medicare Enrollment ID | O20170720002408 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972035772 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Jay Warren Willey |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922029412 PECOS PAC ID: 7719938893 Enrollment ID: I20050209000266 |
| Provider Name | Randy P Vawdrey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376568493 PECOS PAC ID: 1052366242 Enrollment ID: I20050321000907 |
| Provider Name | Trilby M Wedler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710232616 PECOS PAC ID: 1456501998 Enrollment ID: I20121018000691 |
| Provider Name | David J Mcgregor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770924375 PECOS PAC ID: 2668600685 Enrollment ID: I20140120000092 |
| Provider Name | Adam A Packer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669858734 PECOS PAC ID: 4385951037 Enrollment ID: I20150914002010 |
| Provider Name | Titus Kener |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356876551 PECOS PAC ID: 4183994346 Enrollment ID: I20170720000546 |
| Provider Name | Wesley Ward |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881170611 PECOS PAC ID: 0840534418 Enrollment ID: I20181207002500 |
| Provider Name | Sydney Pia Goings |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144869348 PECOS PAC ID: 9638509276 Enrollment ID: I20200422000341 |
| Provider Name | Alex M Carr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013623529 PECOS PAC ID: 8022475938 Enrollment ID: I20230608001635 |
| Provider Name | Shaunna Rae Kramer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457822652 PECOS PAC ID: 6608114384 Enrollment ID: I20231024002801 |
| Provider Name | Adam Landon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922786391 PECOS PAC ID: 5799136651 Enrollment ID: I20240104004703 |
| Provider Name | Leathie Bickmore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609640333 PECOS PAC ID: 9032554175 Enrollment ID: I20240228004836 |
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