Provider Demographics
NPI:1780769075
Name:HILL, KEVIN S (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:S
Last Name:HILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 4168
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83205-4168
Mailing Address - Country:US
Mailing Address - Phone:208-239-2055
Mailing Address - Fax:208-239-3754
Practice Address - Street 1:777 HOSPITAL WAY
Practice Address - Street 2:SUITE G15
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-5175
Practice Address - Country:US
Practice Address - Phone:208-239-2722
Practice Address - Fax:208-239-3759
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM-58522081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002686600Medicaid
IDE93120Medicare UPIN