Mv Pocatello Ent, LLC

NPI #1154801595 in Pocatello, Idaho

Provider Information

NPI Number: 1154801595
Entity Type: Organization
Organization Name: Mv Pocatello Ent, LLC
Primary Specialty: Otolaryngology
Enumeration Date: Aug 15, 2018
Last Updated: Aug 30, 2018

Practice Location

Address: 333 N 18TH AVE STE B3
City: Pocatello
State: Idaho
ZIP Code: 83201
Phone: (208) 232-2146

Authorized Official

Name: NED HILLYARD, CCO
Title: CHIEF COMPLIANCE OFFICER
Phone: (208) 709-4571

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Otolaryngology	207Y00000X	Primary

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