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Organization

MV POCATELLO ENT, LLC

Active
Other names
MVH Gastroenterology LLC
Organization subpart
No

Provider details

NPI number
Authorized official
NED HILLYARD CCO (CHIEF COMPLIANCE OFFICER)
(208) 709-4571
Entity
Organization

Contact information

Practice address
333 N 18TH AVE STE B3, POCATELLO, ID 83201
(208) 232-2146
Mailing address
333 N 18TH AVE STE B3, POCATELLO, ID 83201-3358
(208) 232-2146

Taxonomy

Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary

Other

Enumeration date
08/15/2018
Last updated
08/30/2018
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