| St Joseph Hospital Llc | |
|
341 Saint Johns Way Lewiston ID 83501-2436 | |
| (615) 844-9800 | |
| (615) 844-9883 |
| Full Name | St Joseph Hospital Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 341 Saint Johns Way, Lewiston, Idaho |
| Authorized Official Name and Position | Kathy Teague (VICE PRESIDENT, CORPORATE SECRETARY) |
| Authorized Official Contact | 6292535121 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| St Joseph Hospital Llc 680 S 4th St Louisville KY 40202-2407 Ph: (629) 253-5121 | St Joseph Hospital Llc 341 Saint Johns Way Lewiston ID 83501-2436 Ph: (615) 844-9800 |
| NPI Number | 1205368404 |
|---|---|
| Provider Enumeration Date | 03/28/2017 |
| Last Update Date | 02/07/2023 |
| Medicare PECOS PAC ID | 8325325806 |
|---|---|
| Medicare Enrollment ID | O20170606002496 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205368404 | NPI | - | NPPES |
| 1205368404 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Barbara A Kammer |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306957048 PECOS PAC ID: 9436053980 Enrollment ID: I20031125000725 |
| Provider Name | Mary M Himmler |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1598877896 PECOS PAC ID: 6608858642 Enrollment ID: I20040603000908 |
| Provider Name | Michael S Stormes |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1215069877 PECOS PAC ID: 0941273460 Enrollment ID: I20040813000660 |
| Provider Name | Jane A Fore |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063445385 PECOS PAC ID: 0446243125 Enrollment ID: I20041025000045 |
| Provider Name | Ronald D Jenkins |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1992751648 PECOS PAC ID: 4082672811 Enrollment ID: I20041228000199 |
| Provider Name | Peter G Roan |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1326037342 PECOS PAC ID: 3072597962 Enrollment ID: I20050128000228 |
| Provider Name | Dennis B Cooke |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1285680488 PECOS PAC ID: 3173512605 Enrollment ID: I20050215001091 |
| Provider Name | Graham Wetherley |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1821030586 PECOS PAC ID: 4082698972 Enrollment ID: I20051101000405 |
| Provider Name | Thomas Richard Boubel |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1508982646 PECOS PAC ID: 8729973987 Enrollment ID: I20051206000316 |
| Provider Name | Michael J Baldeck |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669428967 PECOS PAC ID: 7719907625 Enrollment ID: I20051206000686 |
| Provider Name | David Charles Simon |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1518908581 PECOS PAC ID: 1951322148 Enrollment ID: I20051215000442 |
| Provider Name | Liliana C Saunero-nava |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902902737 PECOS PAC ID: 0840282299 Enrollment ID: I20060106000317 |
| Provider Name | Larry D Harries |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033105994 PECOS PAC ID: 4486568581 Enrollment ID: I20060314000503 |
| Provider Name | Gerardo Midence |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1215981832 PECOS PAC ID: 1951304187 Enrollment ID: I20060816000265 |
| Provider Name | Michael T Rooney |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1093753360 PECOS PAC ID: 8628040292 Enrollment ID: I20060816000284 |
| Provider Name | Casey Joseph Johnson |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1518917574 PECOS PAC ID: 7618877879 Enrollment ID: I20061116000387 |
| Provider Name | Gerald Knouf |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609989359 PECOS PAC ID: 2365426608 Enrollment ID: I20061201000433 |
| Provider Name | Patricia A Brady |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1922079037 PECOS PAC ID: 3274518535 Enrollment ID: I20070716000725 |
| Provider Name | Barbara K Davis |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699746859 PECOS PAC ID: 5193700458 Enrollment ID: I20070728000158 |
| Provider Name | Matthew G Krahn |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1144421074 PECOS PAC ID: 9032201603 Enrollment ID: I20070828000085 |
| Provider Name | William A Forsyth |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1467440669 PECOS PAC ID: 5193801017 Enrollment ID: I20080318000476 |
| Provider Name | Mark Edlund |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1699850966 PECOS PAC ID: 8123129913 Enrollment ID: I20080714000549 |
| Provider Name | Daniel B Mcintosh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1801831151 PECOS PAC ID: 1153480835 Enrollment ID: I20081110000808 |
| Provider Name | Kevin J Chicoine |
|---|---|
| Provider Type | Practitioner - Preventive Medicine |
| Provider Identifiers | NPI Number: 1730121740 PECOS PAC ID: 1153483011 Enrollment ID: I20081231000242 |
| Provider Name | Trent M Morgan |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1740306828 PECOS PAC ID: 0941190086 Enrollment ID: I20090423000479 |
| Provider Name | William T Gipson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1174757140 PECOS PAC ID: 3577600618 Enrollment ID: I20091022000473 |
| Provider Name | Mark R Keane |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1427044643 PECOS PAC ID: 3870586126 Enrollment ID: I20091215000438 |
| Provider Name | John G Peterson |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1013931997 PECOS PAC ID: 2769572445 Enrollment ID: I20100222000468 |
| Provider Name | Alice Myra Forsythe |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1437195476 PECOS PAC ID: 1355431305 Enrollment ID: I20100720000210 |
| Provider Name | Ronald M Fritz |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1801842232 PECOS PAC ID: 7113916628 Enrollment ID: I20100913001088 |
| Provider Name | Chad M Lewis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174834535 PECOS PAC ID: 8224153200 Enrollment ID: I20100914000969 |
| Provider Name | Marvin R Kym |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1316932601 PECOS PAC ID: 8123929072 Enrollment ID: I20100915000242 |
| Provider Name | Albert W Merritt |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1609992783 PECOS PAC ID: 5395938849 Enrollment ID: I20101018000371 |
| Provider Name | Donald J Greggain |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154328052 PECOS PAC ID: 8820074669 Enrollment ID: I20110607000534 |
| Provider Name | John C Morgenstern |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1740386432 PECOS PAC ID: 1456529536 Enrollment ID: I20110714000840 |
| Provider Name | Belinda Roberts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457669863 PECOS PAC ID: 6204017551 Enrollment ID: I20110823000748 |
| Provider Name | Angelo S Ferraro |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1740236405 PECOS PAC ID: 0345239877 Enrollment ID: I20110927000180 |
| Provider Name | Michael D Hostetler |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1932155082 PECOS PAC ID: 6901895408 Enrollment ID: I20111227000755 |
| Provider Name | Kevin M Kavanaugh |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1205889433 PECOS PAC ID: 5698764744 Enrollment ID: I20120124000763 |
| Provider Name | John W Ho |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1023096955 PECOS PAC ID: 9830002708 Enrollment ID: I20120716000498 |
| Provider Name | Barry Smith |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1083731103 PECOS PAC ID: 8820254303 Enrollment ID: I20120727000444 |
| Provider Name | Bren Heaton |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1629244355 PECOS PAC ID: 9638325210 Enrollment ID: I20120814000642 |
| Provider Name | Edward L Middleman |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1972540623 PECOS PAC ID: 3870504947 Enrollment ID: I20121023000558 |
| Provider Name | Chuck R Colas |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1831204288 PECOS PAC ID: 0345289708 Enrollment ID: I20130121000158 |
| Provider Name | Fawna S Huffman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356680862 PECOS PAC ID: 6305091653 Enrollment ID: I20130313000019 |
| Provider Name | Eben E Tucker |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1437273166 PECOS PAC ID: 2365356847 Enrollment ID: I20130523000271 |
| Provider Name | Adam D Bell |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1942463799 PECOS PAC ID: 3375784283 Enrollment ID: I20130718000305 |
| Provider Name | Sallee E Jones |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1952635609 PECOS PAC ID: 4183867187 Enrollment ID: I20130823000153 |
| Provider Name | Jean K Thomas |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1881695534 PECOS PAC ID: 1951442896 Enrollment ID: I20130912000830 |
| Provider Name | Thadeus B Koontz |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1609010156 PECOS PAC ID: 3072757012 Enrollment ID: I20130913000262 |
| Provider Name | Talmadge C Caviness |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1497870091 PECOS PAC ID: 2567596794 Enrollment ID: I20130913000458 |
| Provider Name | Dustin Lee Elben |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1376976456 PECOS PAC ID: 8022243435 Enrollment ID: I20131021000075 |
| Provider Name | April L Christenson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912332370 PECOS PAC ID: 3870728546 Enrollment ID: I20131105001298 |
| Provider Name | Tamara L Bruns |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578886305 PECOS PAC ID: 5496884934 Enrollment ID: I20140324000712 |
| Provider Name | April Golla |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972919447 PECOS PAC ID: 8820216385 Enrollment ID: I20140825001316 |
| Provider Name | Mandi Lee Strohm |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1568887156 PECOS PAC ID: 5193958163 Enrollment ID: I20150226000375 |
| Provider Name | Eric L. Wallace |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1568658243 PECOS PAC ID: 6709939291 Enrollment ID: I20150519002539 |
| Provider Name | Laurel Andrechak |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992907372 PECOS PAC ID: 6305873936 Enrollment ID: I20150708000750 |
| Provider Name | Dorian Larsen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356489041 PECOS PAC ID: 4587977780 Enrollment ID: I20150716002956 |
| Provider Name | Clinton R Morgan |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1376779413 PECOS PAC ID: 4284899774 Enrollment ID: I20150812008306 |
| Provider Name | Michele R Dickison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841687001 PECOS PAC ID: 5991012833 Enrollment ID: I20150910000042 |
| Provider Name | James J Butler |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1679823926 PECOS PAC ID: 3173764073 Enrollment ID: I20160114001385 |
| Provider Name | Lee J Hixson |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1952314593 PECOS PAC ID: 7517956337 Enrollment ID: I20160324001906 |
| Provider Name | Ryan Uptmor |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1508280256 PECOS PAC ID: 4587895602 Enrollment ID: I20160421002445 |
| Provider Name | Michael S Richins |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1497028609 PECOS PAC ID: 4981929767 Enrollment ID: I20160811000944 |
| Provider Name | Jason L Andersen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1932293727 PECOS PAC ID: 8123924198 Enrollment ID: I20161011003259 |
| Provider Name | Brian Francis Ciezki |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205221041 PECOS PAC ID: 5294056305 Enrollment ID: I20161108001344 |
| Provider Name | John Siebel |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1780741306 PECOS PAC ID: 7517021082 Enrollment ID: I20161111001448 |
| Provider Name | John Bradley Rudolph |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548503022 PECOS PAC ID: 1759604309 Enrollment ID: I20170116000186 |
| 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 | James Vodvarka |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518955210 PECOS PAC ID: 9335191600 Enrollment ID: I20170220001388 |
| Provider Name | Sean C Banks |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1720374648 PECOS PAC ID: 5395915649 Enrollment ID: I20170221001659 |
| Provider Name | Oxana V Norvell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134454879 PECOS PAC ID: 1153460498 Enrollment ID: I20170322002877 |
| Provider Name | Susanne Choby |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1033310719 PECOS PAC ID: 8224118013 Enrollment ID: I20170425001239 |
| Provider Name | Donald Engles |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1306163134 PECOS PAC ID: 8123320942 Enrollment ID: I20170522002110 |
| Provider Name | Brian Fulton |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1700843646 PECOS PAC ID: 7719011469 Enrollment ID: I20170629003028 |
| Provider Name | Pushapdeep K Brar |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1699097279 PECOS PAC ID: 0244400109 Enrollment ID: I20170713001851 |
| Provider Name | Yokesh Balaraman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1134431927 PECOS PAC ID: 1456597236 Enrollment ID: I20170815003221 |
| Provider Name | Mohit Jain |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1659557254 PECOS PAC ID: 8325190341 Enrollment ID: I20170818001895 |
| Provider Name | Sheila G Garvey |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1245227792 PECOS PAC ID: 9032298641 Enrollment ID: I20170829004435 |
| Provider Name | Wendy E Morley |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1962848903 PECOS PAC ID: 6800020223 Enrollment ID: I20170830003326 |
| Provider Name | Angie Shantie |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659734143 PECOS PAC ID: 3678847282 Enrollment ID: I20170920003260 |
| Provider Name | Paula K Lockhart |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1801928213 PECOS PAC ID: 2365508322 Enrollment ID: I20171026003301 |
| Provider Name | Heather Cumbo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1063668077 PECOS PAC ID: 1153649124 Enrollment ID: I20171101002760 |
| Provider Name | Richard J. Lambert |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1659318798 PECOS PAC ID: 2062404791 Enrollment ID: I20171209000388 |
| Provider Name | Amy Dawnette Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144557653 PECOS PAC ID: 7416215942 Enrollment ID: I20171211001507 |
| Provider Name | Lisa Henderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912419243 PECOS PAC ID: 3870853724 Enrollment ID: I20180214001278 |
| Provider Name | Julie Len Funke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285091306 PECOS PAC ID: 5698072429 Enrollment ID: I20180521001100 |
| Provider Name | Sarah Andrus |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1619324324 PECOS PAC ID: 4486946068 Enrollment ID: I20180530000165 |
| Provider Name | Curtis K Li |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1669409678 PECOS PAC ID: 6608881222 Enrollment ID: I20180611001707 |
| Provider Name | Samantha Lynn Musser |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174017701 PECOS PAC ID: 7416204193 Enrollment ID: I20180726001298 |
| Provider Name | Marion T Chirayath |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1760438139 PECOS PAC ID: 4587652375 Enrollment ID: I20180912001789 |
| Provider Name | Andrew D Michaels |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1588618250 PECOS PAC ID: 9234132317 Enrollment ID: I20181008001304 |
| Provider Name | Mark B Hazuka |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1750361259 PECOS PAC ID: 2769516830 Enrollment ID: I20181024002370 |
| Provider Name | Norman Robert Willis |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1508854290 PECOS PAC ID: 0244261154 Enrollment ID: I20181024002537 |
| Provider Name | Amy Kelley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619328044 PECOS PAC ID: 3779823828 Enrollment ID: I20190327002241 |
| Provider Name | Pamela Jean Wieters |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649629700 PECOS PAC ID: 7214278605 Enrollment ID: I20190411003079 |
| Provider Name | James T Lawyer |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1417068719 PECOS PAC ID: 2567452105 Enrollment ID: I20190702002884 |
| Provider Name | Purushothaman Muthusamy |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1033473285 PECOS PAC ID: 8426287871 Enrollment ID: I20190806004069 |
| Provider Name | Ellen H Chen |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1083654313 PECOS PAC ID: 0042104523 Enrollment ID: I20190823001421 |
| Provider Name | Lori Beth Bennett |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1093007304 PECOS PAC ID: 0244471340 Enrollment ID: I20190829004364 |
| Provider Name | Elizabeth M Rau |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1538455878 PECOS PAC ID: 4688994759 Enrollment ID: I20190903002403 |
| Provider Name | Kenneth Raynor Ellington |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1144244112 PECOS PAC ID: 7810965084 Enrollment ID: I20190904000224 |
| Provider Name | Terry Allen Cline |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1245281344 PECOS PAC ID: 9335053719 Enrollment ID: I20190904000545 |
| Provider Name | Grover Scott Cruise |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1720043219 PECOS PAC ID: 1254376213 Enrollment ID: I20190924003612 |
| Provider Name | Jesse Hyrum Hansen |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1255885927 PECOS PAC ID: 6901193226 Enrollment ID: I20190925003721 |
| Provider Name | Lindsey Nelson |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1568478758 PECOS PAC ID: 7517949621 Enrollment ID: I20191007002077 |
| Provider Name | Tracy Lee Drish |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1285796599 PECOS PAC ID: 4183889959 Enrollment ID: I20191014002333 |
| Provider Name | Kyle James Daly |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1003465360 PECOS PAC ID: 8426389834 Enrollment ID: I20191016003000 |
| Provider Name | Paolo Romero |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1962409235 PECOS PAC ID: 6800928847 Enrollment ID: I20200415000217 |
| Provider Name | Daniel Eugene Williams |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1508809252 PECOS PAC ID: 8628980364 Enrollment ID: I20200727001986 |
| Provider Name | Kenneth Gibbs |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1174506455 PECOS PAC ID: 7315926847 Enrollment ID: I20200930002783 |
| Provider Name | Kent Winkler |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1972506277 PECOS PAC ID: 9032195094 Enrollment ID: I20201007001479 |
| Provider Name | John W Rieke |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1811934425 PECOS PAC ID: 9032121827 Enrollment ID: I20201210002564 |
| Provider Name | Khadijeh Zarkoob |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1295705630 PECOS PAC ID: 1153343207 Enrollment ID: I20201214000443 |
| Provider Name | Edward Kim |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1386752913 PECOS PAC ID: 0345288916 Enrollment ID: I20201216003017 |
| Provider Name | Jonathan Boyd |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306334974 PECOS PAC ID: 7113278680 Enrollment ID: I20210721004245 |
| Provider Name | Mark Troiano |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1962636696 PECOS PAC ID: 9335454453 Enrollment ID: I20210906000010 |
| Provider Name | Amanda Caye Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184391146 PECOS PAC ID: 9032517834 Enrollment ID: I20211008000825 |
| Provider Name | Chelsy Sheppard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568059681 PECOS PAC ID: 5092120808 Enrollment ID: I20211013001169 |
| Provider Name | Carley Stringer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417564014 PECOS PAC ID: 8729481460 Enrollment ID: I20211103002981 |
| Provider Name | Maggie Rosalie Bolon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932678315 PECOS PAC ID: 6103215066 Enrollment ID: I20211115001574 |
| Provider Name | Mary Schmidt |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578824710 PECOS PAC ID: 7719265404 Enrollment ID: I20211123001542 |
| Provider Name | David Grubb |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1114127412 PECOS PAC ID: 9436144193 Enrollment ID: I20220104001346 |
| Provider Name | Ahmed Mohamed Ghany |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1275730285 PECOS PAC ID: 0749341451 Enrollment ID: I20220114001929 |
| Provider Name | Tyler Howard Buckley |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1407299522 PECOS PAC ID: 0244553048 Enrollment ID: I20220324000793 |
| Provider Name | Abeer Arain |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1962851519 PECOS PAC ID: 1052662335 Enrollment ID: I20220427001496 |
| Provider Name | Erik Cooper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275893968 PECOS PAC ID: 5890941900 Enrollment ID: I20220527000673 |
| Provider Name | Charles Q Cui |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1356737670 PECOS PAC ID: 6002120938 Enrollment ID: I20220725000301 |
| Provider Name | Tony O Haley |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1154317220 PECOS PAC ID: 7416022892 Enrollment ID: I20230110001371 |
| Provider Name | Esther Spataro |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619611415 PECOS PAC ID: 4688045735 Enrollment ID: I20230127002080 |
| Provider Name | Dori Jean Foster |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497316665 PECOS PAC ID: 4789056938 Enrollment ID: I20230216000379 |
| Provider Name | Tiffany E Wells |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821509183 PECOS PAC ID: 4587922554 Enrollment ID: I20230316002817 |
| Provider Name | Christina Cooper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518202175 PECOS PAC ID: 1355588427 Enrollment ID: I20230427001197 |
| Provider Name | Kayla Miller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972280592 PECOS PAC ID: 9133580707 Enrollment ID: I20230728001734 |
| Provider Name | Ismaila Bello |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1679803274 PECOS PAC ID: 8325360449 Enrollment ID: I20230809003737 |
| Provider Name | Jenna Darnell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447033386 PECOS PAC ID: 6800259136 Enrollment ID: I20230901003087 |
| Provider Name | Samuel Bieligk |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1982618112 PECOS PAC ID: 2567423999 Enrollment ID: I20240318002670 |
Southway Internists Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 222 Southway, Suite C, Lewiston, ID 83501 Phone: 208-746-1333 Fax: 208-746-8090 | |
St Joseph Hospital Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 341 Saint Johns Way, Lewiston, ID 83501 Phone: 615-844-9800 Fax: 615-844-9883 | |
Laennec Inpatient Services Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 415 6th St, Lewiston, ID 83501 Phone: 208-799-5522 | |
St. Joseph Medical Group Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 415 6th St, Lewiston, ID 83501 Phone: 208-743-2511 Fax: 208-799-5528 | |
Sterling Provider Group Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2201 Thain Grade, Lewiston, ID 83501 Phone: 208-717-3100 Fax: 208-717-3099 | |
North Central District Health Department Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 215 10th St, Lewiston, ID 83501 Phone: 208-799-0349 |