MVH Pic LLC
Organization Active NPI Family Medicine Physician · Pocatello, ID
NPI 1972035772 · NPPES record last updated Apr 24, 2024
Key facts
- NPI
- 1972035772
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- MVH PIC LLC
- Practice address
- 495 Yellowstone Ave
Pocatello, ID 83201-4531 - Phone
- (208) 478-7422
- NPI assigned
- Mar 30, 2017
- Organization subpart
- No
Authorized official
- Name
- Ned Hillyard
- Title
- Cco
- Phone
- (208) 709-4571
Member of 1
Practitioners 22
-
Janeane Robinson, CNP
-
Joshua Shane Blanchard, PA-C
-
Nicholas A Hale, PA
-
Rachelle Alice Jaramillo, PA-C
-
Shaunna Rae Kramer, NP-C
-
Adam Landon, FNP-C
-
Adam Packer, NP
-
Wiley D Petersen, PA-C
-
Leathie Yeaman, APRN CNP
-
Jenny May Ball, FNP
-
Alex Michael Carr, FNP
-
Trilby M Wedler, NURSE PRACTITIONER
-
Robert Charles Barkus, PA-C
-
Sydney Pia Hernandez, FNP-C
-
Ashley Morgan Klink, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170720002408 | ID | Part B Supplier - Clinic/Group Practice | 6709156904 |
Receives reassigned benefits from 21 practitioners Practice locations: Pocatello, ID; Chubbuck, ID |
National Provider Directory
Locations
134 W Chubbuck Rd
Ste B
Chubbuck, ID 83202
Phone (208) 237-7911
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
495 Yellowstone Ave
Pocatello, ID 83201-4531
Mailing address
495 Yellowstone Ave
Pocatello, ID 83201-4531
Phone (208) 478-7422
Other practice location 1
134 W Chubbuck Rd
Chubbuck, ID 83202-2338
Phone (208) 478-7422
Other providers in Pocatello, ID
- Virginia Ann Murphy
- Morgan Elizabeth Murray
- MV Pocatello ENT, LLC
- MVH Endoscopy LLC
- MVH PC Specialists LLC
- MVH PMHS LLC
- MVH Surgical Specialists LLC
- Austin Cliff Myers
- Ernie Naftzger
- Lauryn Rose Nakamura
All providers in Pocatello, ID · Family Medicine Physician in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 24, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.