| Clearwater Valley Hospital Clinic | |
|
301 Cedar St Orofino ID 83544-9029 | |
| (208) 476-4555 | |
| (208) 476-5385 |
| Full Name | Clearwater Valley Hospital Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 301 Cedar St, Orofino, Idaho |
| Authorized Official Name and Position | Lenne J Bonner (CFO) |
| Authorized Official Contact | 2084764555 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clearwater Valley Hospital Clinic 301 Cedar St Orofino ID 83544-9029 Ph: (208) 476-4555 | Clearwater Valley Hospital Clinic 301 Cedar St Orofino ID 83544-9029 Ph: (208) 476-4555 |
| NPI Number | 1073551396 |
|---|---|
| Provider Enumeration Date | 06/02/2006 |
| Last Update Date | 05/08/2014 |
| Medicare PECOS PAC ID | 0547173346 |
|---|---|
| Medicare Enrollment ID | O20031117000264 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073551396 | NPI | - | NPPES |
| 805060900 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 363A00000X | Physician Assistant | (* (Not Available)) | Secondary |
| Provider Name | Brett T Mumford |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1164463113 PECOS PAC ID: 4880592112 Enrollment ID: I20031223000750 |
| Provider Name | Kelly J Mcgrath |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609871060 PECOS PAC ID: 7012800956 Enrollment ID: I20040205000112 |
| Provider Name | Jane A Fore |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063445385 PECOS PAC ID: 0446243125 Enrollment ID: I20041025000045 |
| Provider Name | Charity Dawn Robinson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972508497 PECOS PAC ID: 2668411034 Enrollment ID: I20050426001110 |
| Provider Name | Christin S Reisenauer |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1205802998 PECOS PAC ID: 0345208294 Enrollment ID: I20060123000862 |
| Provider Name | Wendi Rene Boyer |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1538101050 PECOS PAC ID: 9638140783 Enrollment ID: I20060830000452 |
| Provider Name | Clayton J Bunt |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578646345 PECOS PAC ID: 8820099641 Enrollment ID: I20070122000641 |
| Provider Name | Benjamin R Perschau |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1215149141 PECOS PAC ID: 6608968599 Enrollment ID: I20070823000306 |
| Provider Name | Edward Gerard Detar |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1194706465 PECOS PAC ID: 6002805868 Enrollment ID: I20080912000184 |
| Provider Name | Vanessa K Brown |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295816502 PECOS PAC ID: 4880762103 Enrollment ID: I20081014000060 |
| Provider Name | Richard Howe |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871566679 PECOS PAC ID: 0446221337 Enrollment ID: I20100706000450 |
| Provider Name | Dean C Easton |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1407807266 PECOS PAC ID: 2264426204 Enrollment ID: I20110923000273 |
| Provider Name | Robert M Farner |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1154313088 PECOS PAC ID: 8224016969 Enrollment ID: I20120413000035 |
| Provider Name | Curtis Meske |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578509147 PECOS PAC ID: 3678533155 Enrollment ID: I20120620000624 |
| Provider Name | Peter N Nelson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1134275365 PECOS PAC ID: 4688751514 Enrollment ID: I20121115000395 |
| Provider Name | Colleen P Sholar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770813917 PECOS PAC ID: 0840479465 Enrollment ID: I20140801001022 |
| Provider Name | Ann J Lima |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780978320 PECOS PAC ID: 1052545605 Enrollment ID: I20150317000784 |
| Provider Name | Amy S Smith |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1508917048 PECOS PAC ID: 9830364660 Enrollment ID: I20150730013400 |
| Provider Name | Rebecca Susan Katzman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679869325 PECOS PAC ID: 7214174119 Enrollment ID: I20150923001893 |
| Provider Name | Karin Schmidova |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1295949519 PECOS PAC ID: 5991872152 Enrollment ID: I20160720001023 |
| Provider Name | Taresa L Michna |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467901330 PECOS PAC ID: 2062790124 Enrollment ID: I20161025002277 |
| Provider Name | Keith A Howell |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1275626947 PECOS PAC ID: 6608837372 Enrollment ID: I20170125000248 |
| Provider Name | Erin J Massey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376884593 PECOS PAC ID: 3779866140 Enrollment ID: I20170208002717 |
| Provider Name | Leslie Jacob Benny |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1780002717 PECOS PAC ID: 2163791500 Enrollment ID: I20170628002755 |
| Provider Name | Thomas W Wonderlich |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982016788 PECOS PAC ID: 8022327469 Enrollment ID: I20170731002852 |
| Provider Name | John S Lukens |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801089834 PECOS PAC ID: 3870771140 Enrollment ID: I20171026001072 |
| Provider Name | Peter Razma |
|---|---|
| Provider Type | Practitioner - Sleep Medicine |
| Provider Identifiers | NPI Number: 1609867183 PECOS PAC ID: 7911992672 Enrollment ID: I20190717000747 |
| Provider Name | Aaron J Chalmers |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1639352719 PECOS PAC ID: 9335390590 Enrollment ID: I20200630002383 |
| Provider Name | Julia Lienesch |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1043623309 PECOS PAC ID: 0840418463 Enrollment ID: I20210408002707 |
| Provider Name | Shelly F Frayser |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1912068131 PECOS PAC ID: 9133307739 Enrollment ID: I20210701003780 |
| Provider Name | Patrick C Marvil |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235629304 PECOS PAC ID: 7517369556 Enrollment ID: I20210816003765 |
| Provider Name | Cameron Mackay Jones |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811551583 PECOS PAC ID: 3779960463 Enrollment ID: I20220518002471 |
| Provider Name | John Nuhn |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1144714973 PECOS PAC ID: 0547682619 Enrollment ID: I20220709000370 |
| Provider Name | John Kenny |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1750449732 PECOS PAC ID: 9739102716 Enrollment ID: I20220901003495 |
| Provider Name | Allyson Stewart |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225685142 PECOS PAC ID: 6901239045 Enrollment ID: I20220915003823 |
| Provider Name | Danielle Hammons |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598319246 PECOS PAC ID: 9436588951 Enrollment ID: I20221003000154 |
| Provider Name | Nicholas B Henrie |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487229324 PECOS PAC ID: 3870995723 Enrollment ID: I20221206003415 |
| Provider Name | Wanda K Terry |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1982714424 PECOS PAC ID: 5496756660 Enrollment ID: I20230103001460 |
| Provider Name | Felix A Geller |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1902073216 PECOS PAC ID: 2163672684 Enrollment ID: I20230103002253 |
| Provider Name | Saraswathi Tirumalasetty |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1821006172 PECOS PAC ID: 1355606401 Enrollment ID: I20230103002423 |
| Provider Name | Jessica E Campbell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598186801 PECOS PAC ID: 6800025784 Enrollment ID: I20230112001583 |
| Provider Name | Caroline Tomlinson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659842987 PECOS PAC ID: 2668710161 Enrollment ID: I20230112002455 |
| Provider Name | Giancarlo Colon Vilar |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1508151762 PECOS PAC ID: 2961708334 Enrollment ID: I20230125003076 |
| Provider Name | Emily Grohman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285138024 PECOS PAC ID: 0547523433 Enrollment ID: I20230127000909 |
| Provider Name | Malaika Adams |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1063875847 PECOS PAC ID: 6608296645 Enrollment ID: I20230127001040 |
| Provider Name | Sara K Flores |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1073768248 PECOS PAC ID: 5294911608 Enrollment ID: I20230127001736 |
| Provider Name | Elton R Naidoo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1366619892 PECOS PAC ID: 9335387943 Enrollment ID: I20230127002869 |
| Provider Name | Daryl Tanski |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1497809834 PECOS PAC ID: 7012937311 Enrollment ID: I20230131003292 |
| Provider Name | Hector L Rivera Reyes |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1457583585 PECOS PAC ID: 9739302340 Enrollment ID: I20230207001403 |
| Provider Name | Renee Brunner-houser |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952719650 PECOS PAC ID: 0042532152 Enrollment ID: I20230207002795 |
| Provider Name | Andre J Sullivan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1023162559 PECOS PAC ID: 6406917285 Enrollment ID: I20230207002892 |
| Provider Name | Jane Waweru |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033606165 PECOS PAC ID: 1759631146 Enrollment ID: I20230214002363 |
| Provider Name | Brooke Ellen Potratz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184245185 PECOS PAC ID: 6800268921 Enrollment ID: I20230217000778 |
| Provider Name | Jonathan Lee Hulkower |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1063597961 PECOS PAC ID: 0749323343 Enrollment ID: I20230228002661 |
| Provider Name | Nicole R Walls |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366151870 PECOS PAC ID: 3577929967 Enrollment ID: I20230509001684 |
| Provider Name | Casey A Rahaley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447728019 PECOS PAC ID: 7719223973 Enrollment ID: I20230728002021 |
| Provider Name | Karen Schaaf |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295704484 PECOS PAC ID: 8628099561 Enrollment ID: I20230802002383 |
| Provider Name | Talia San Roman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760929152 PECOS PAC ID: 2860776382 Enrollment ID: I20230808001644 |
| Provider Name | Lindsay Waggerman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386203339 PECOS PAC ID: 6103293899 Enrollment ID: I20230821001078 |
| Provider Name | Sriraman Srinivasan |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1457510059 PECOS PAC ID: 6103950332 Enrollment ID: I20230823001090 |
| Provider Name | Diana Smith |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1194930917 PECOS PAC ID: 0244410181 Enrollment ID: I20230901003358 |
| Provider Name | Kymberly R Ross |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437242724 PECOS PAC ID: 9032212576 Enrollment ID: I20230906003876 |
| Provider Name | Phebe L Alley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295355279 PECOS PAC ID: 9234552738 Enrollment ID: I20230911002414 |
| Provider Name | Ally Lynn Loveland |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780200592 PECOS PAC ID: 8729485594 Enrollment ID: I20230922003118 |
| Provider Name | Alvaro Moreno |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1063603256 PECOS PAC ID: 6709011968 Enrollment ID: I20230926001690 |
| Provider Name | Sandra Horvath Dori |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1689666927 PECOS PAC ID: 5092606848 Enrollment ID: I20231003003865 |
| Provider Name | Aaron Andrews |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1083796387 PECOS PAC ID: 9234224130 Enrollment ID: I20231220003377 |
| Provider Name | Curtis J Willis |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1215463351 PECOS PAC ID: 3678841525 Enrollment ID: I20240130003407 |
| Provider Name | Elchin Zeynalov |
|---|---|
| Provider Type | Practitioner - Sleep Medicine |
| Provider Identifiers | NPI Number: 1437499365 PECOS PAC ID: 4284877051 Enrollment ID: I20240514003785 |
Clearwater Valley Health Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 301 Cedar St, Orofino, ID 83544 Phone: 208-476-4555 Fax: 208-476-5385 | |
Orofino Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 301 Cedar St, Orofino, ID 83544 Phone: 208-476-4555 Fax: 208-476-5385 | |
Kooskia Medical Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 301 Cedar St, Orofino, ID 83544 Phone: 208-476-4555 Fax: 208-476-5385 |