| Mvh Pmhs Llc | |
|
475 Yellowstone Ave Ste E Pocatello ID 83201-4528 | |
| (208) 232-0021 | |
| Not Available |
| Full Name | Mvh Pmhs Llc |
|---|---|
| Speciality | Counselor |
| Location | 475 Yellowstone Ave, Pocatello, Idaho |
| Authorized Official Name and Position | Ned Hillyard (CHIEF COMPLIANCE OFFICER) |
| Authorized Official Contact | 2087094571 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mvh Pmhs Llc 475 Yellowstone Ave Ste E Pocatello ID 83201-4528 Ph: (208) 232-0021 | Mvh Pmhs Llc 475 Yellowstone Ave Ste E Pocatello ID 83201-4528 Ph: (208) 232-0021 |
| NPI Number | 1649704248 |
|---|---|
| Provider Enumeration Date | 04/20/2017 |
| Last Update Date | 04/20/2017 |
| Medicare PECOS PAC ID | 9436422045 |
|---|---|
| Medicare Enrollment ID | O20170901002162 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649704248 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Randy P Vawdrey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376568493 PECOS PAC ID: 1052366242 Enrollment ID: I20050321000907 |
| Provider Name | David A Fife |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1659569697 PECOS PAC ID: 4789771312 Enrollment ID: I20141216000230 |
| 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 |
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