Provider Demographics
NPI:1972035772
Name:MVH PIC LLC
Entity Type:Organization
Organization Name:MVH PIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CCO
Authorized Official - Prefix:
Authorized Official - First Name:NED
Authorized Official - Middle Name:
Authorized Official - Last Name:HILLYARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-709-4571
Mailing Address - Street 1:495 YELLOWSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-4531
Mailing Address - Country:US
Mailing Address - Phone:208-478-7422
Mailing Address - Fax:
Practice Address - Street 1:495 YELLOWSTONE AVE
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4531
Practice Address - Country:US
Practice Address - Phone:208-478-7422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty