Basic Information
| Provider Information | |||||||||
| NPI: | 1699141150 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOUNTAIN VIEW HOSPITAL LLC | ||||||||
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| OtherOrganizationName: | PAIN AND SPINE SPECIALISTS OF IDAHO | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2325 CORONADO ST | ||||||||
| Address2: | |||||||||
| City: | IDAHO FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 834047407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2085572700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1595 YELLOWSTONE AVE | ||||||||
| Address2: | |||||||||
| City: | POCATELLO | ||||||||
| State: | ID | ||||||||
| PostalCode: | 832014203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2085227246 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2015 | ||||||||
| LastUpdateDate: | 09/23/2015 | ||||||||
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| AuthorizedOfficialLastName: | HILLYARD | ||||||||
| AuthorizedOfficialFirstName: | NED | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF COMPLIANCE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2085572711 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MOUNTAIN VIEW HOSPITAL LLC | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0000X | ID | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
No ID Information.