| West Valley Medical Group Llc | |
|
1906 Fairview Ave Ste 230 Caldwell ID 83605-5432 | |
| (208) 459-4667 | |
| (208) 442-6520 |
| Full Name | West Valley Medical Group Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1906 Fairview Ave Ste 230, Caldwell, Idaho |
| Authorized Official Name and Position | Louis Joseph (VP) |
| Authorized Official Contact | 6153737630 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| West Valley Medical Group Llc 2000 Health Park Dr Brentwood TN 37027-4525 Ph: (615) 373-7600 | West Valley Medical Group Llc 1906 Fairview Ave Ste 230 Caldwell ID 83605-5432 Ph: (208) 459-4667 |
| NPI Number | 1871673798 |
|---|---|
| Provider Enumeration Date | 10/16/2006 |
| Last Update Date | 01/02/2023 |
| Medicare PECOS PAC ID | 8729180310 |
|---|---|
| Medicare Enrollment ID | O20070228000567 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871673798 | NPI | - | NPPES |
| 807981600 | Medicaid | ID | |
| 807655500 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Steven J Koga |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1144275512 PECOS PAC ID: 9032101043 Enrollment ID: I20040721001720 |
| Provider Name | Richard A Montgomery |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1275567638 PECOS PAC ID: 3476527169 Enrollment ID: I20040819001078 |
| Provider Name | Karen Bean |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326132432 PECOS PAC ID: 5496858920 Enrollment ID: I20070321000273 |
| Provider Name | J'cinda J Bitters |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104089556 PECOS PAC ID: 1254509409 Enrollment ID: I20110714000493 |
| Provider Name | Robert S Thacker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124309224 PECOS PAC ID: 7517126659 Enrollment ID: I20120309000325 |
| Provider Name | Travis Reed Moulton |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760744403 PECOS PAC ID: 9638308091 Enrollment ID: I20140218001104 |
| Provider Name | Rebecca A Swainston |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508201757 PECOS PAC ID: 0446550495 Enrollment ID: I20151124002402 |
| Provider Name | Nadezhda Kravchuk |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033686076 PECOS PAC ID: 5698016988 Enrollment ID: I20190415002189 |
| Provider Name | Blake Mcdonald |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396379475 PECOS PAC ID: 9335565423 Enrollment ID: I20200819004273 |
| Provider Name | Suzanne Elise Mcreynolds |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477204634 PECOS PAC ID: 7618355017 Enrollment ID: I20220525001502 |
| Provider Name | Linnae Frisby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780303966 PECOS PAC ID: 7012389448 Enrollment ID: I20230214000696 |
| Provider Name | Colt Kennington |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1386106268 PECOS PAC ID: 5395139612 Enrollment ID: I20230814003867 |
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