Organization Active NPI

MVH Surgical Specialists LLC

  • Surgery Physician
  • Pocatello, ID
National Provider Identifier
1013455914
Registry record updated Feb 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
MVH SURGICAL SPECIALISTS LLC
Practice address
150 Vista Dr.
Pocatello, ID 83201-2600
Phone
(208) 904-0744
Fax
(208) 542-4287
NPI assigned
Feb 10, 2017
Last updated
Feb 17, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ned W Hillyard
Title
Chief Compliance Officer
Phone
(208) 709-4571

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X NU Primary

Addresses

Primary practice location

150 Vista Dr.
Pocatello, ID 83201-2600

Mailing address

150 Vista Drive
Pocatello, ID 83201
Phone (208) 904-0744

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190315001090 ID Part B Supplier - Clinic/Group Practice 4183964885 Receives reassigned benefits from 4 practitioners
Practice locations: Idaho Falls, ID; Pocatello, ID

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

2240 E Center St
Pocatello, ID 83201
Phone (208) 233-2100

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1486684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676592000000",
    "number": "1013455914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 VISTA DRIVE",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "83201",
            "telephone_number": "208-904-0744",
            "fax_number": "208-542-4287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 VISTA DR.",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832012600",
            "telephone_number": "208-904-0744",
            "fax_number": "208-542-4287"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MVH SURGICAL SPECIALISTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-10",
        "last_updated": "2023-02-17",
        "certification_date": "2023-02-14",
        "status": "A",
        "authorized_official_last_name": "HILLYARD",
        "authorized_official_first_name": "NED",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CHIEF COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "208-709-4571"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pocatello, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.