Lily J Wittich (NPI# 1710273057, PAC ID# 8729207139) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is FAMILY MEDICINE.
| Nation Provider ID (NPI) | 1710273057 |
| PAC ID by PECOS | 8729207139 |
| Professional Enrollment ID | I20151030001511 |
| Full Name | Lily J Wittich |
| Organization Legal Name | ST LUKES CLINIC-TREASURE VALLEY LLC |
| Address |
840 N 4th Mountain Home ID 83647-2137 |
| Phone Number | 2083221680 |
| Gender | F |
| Medical School | OREGON HEALTH SCIENCES UNIVERSITY SCHOOL OF MEDICINE |
| Graduation Year | 2011 |
| Primary Specialty | FAMILY MEDICINE |
| Group Practice PAC ID | 4981878402 |
| Number of Group Practice Members | 770 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 130006 | ST LUKE'S REGIONAL MEDICAL CENTER |
| 381315 | ST. ALPHONSUS MEDICAL CENTER - BAKER CITY |
| 130071 | ST LUKE'S NAMPA MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 3445 Pocahontas Rd, Baker City, OR 97814-3599 | 5415231001 | ST LUKES CLINIC-TREASURE VALLEY LLC |
| 3950 17th St, Baker City, OR 97814-1300 | 5415231001 | ST LUKES CLINIC-TREASURE VALLEY LLC |
| 840 N 4th, Mountain Home, ID 83647-2137 | 2083221680 | ST LUKES CLINIC-TREASURE VALLEY LLC |
| Organization Legal Name | ST LUKES CLINIC-TREASURE VALLEY LLC |
| Physicians | 831 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Eric Scholten | Pulmonary Disease | St Lukes Clinic-treasure Valley LLC | 1210 Nw 16th St, Fruitland, ID 83619-2202 |
| Tracye J Lawyer | Orthopedic Surgery | St Lukes Clinic-treasure Valley LLC | 9850 St Lukes Dr, Suite 215, Nampa, ID 83687-7912 |
| Alex Mari Tanabe | Internal Medicine | St Lukes Clinic-treasure Valley LLC | 600 N Robbins Rd, Boise, ID 83702-4565 |
| Jessica J Carpenter | Clinical Social Worker | St Lukes Clinic-treasure Valley LLC | 1620 S Kimball Ave, Caldwell, ID 83605-4547 |
| Whitney B Conrad | Nurse Practitioner | St Lukes Clinic-treasure Valley LLC | 1226 W River St, Boise, ID 83702-7049 |
| Megan D Larson | Nurse Practitioner | St Lukes Clinic-treasure Valley LLC | 287 W Jefferson St, Boise, ID 83702-6045 |
| Bonnie M Reed | Family Medicine | St Lukes Clinic-treasure Valley LLC | 3090 E Gentry Way, Suite 200, Meridian, ID 83642-3550 |
| Scott J Chyna | Clinical Social Worker | St Lukes Clinic-treasure Valley LLC | 703 S Americana Blvd, Suite 150, Boise, ID 83702-4976 |
| Sarah J Mooseau | Qualified Audiologist | St Lukes Clinic-treasure Valley LLC | 510 N 2nd St, Suite 201, Boise, ID 83702-6078 |
| Nitya Alluri | Hematology | St Lukes Clinic-treasure Valley LLC | 100 E Idaho St, Suite 302, Boise, ID 83712-6269 |
| Street Address |
840 N 4TH |
| City | MOUNTAIN HOME |
| State | ID |
| Zip | 83647-2137 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Guy E Grooms | Orthopedic Surgery | North Canyon Medical Center Inc | 840 N 4th, Mountain Home, ID 83647-2166 |
| Jamie R Knapp | Physician Assistant | St Lukes Clinic-treasure Valley LLC | 840 N 4th, Mountain Home, ID 83647-2137 |
| Timothy M Ruth | Family Medicine | St Lukes Clinic-treasure Valley LLC | 840 N 4th, Mountain Home, ID 83647-2137 |
| Karen A Galvan | General Surgery | St Lukes Clinic-treasure Valley LLC | 840 N 4th, Mountain Home, ID 83647-2137 |
| Joseph W Hoskin | Physician Assistant | St Lukes Clinic-treasure Valley LLC | 840 N 4th, Mountain Home, ID 83647-2137 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Mary K Jenks | Nurse Practitioner | St Lukes Clinic-treasure Valley LLC | 465 Mckenna Dr, Mountain Home, ID 83647-2143 |
| Whitney A Roberts | Physician Assistant | St Lukes Clinic-treasure Valley LLC | 465 Mckenna Dr, Mountain Home, ID 83647-2143 |
| Dennis D Crossley | Family Medicine | St Lukes Clinic-treasure Valley LLC | 465 Mckenna Dr, Mountain Home, ID 83647-2143 |
| Michelle Pehrson | Nurse Practitioner | St Lukes Clinic-treasure Valley LLC | 465 Mckenna Dr, Mountain Home, ID 83647-2143 |
| Michael S Charme | Family Medicine | St Lukes Clinic-treasure Valley LLC | 465 Mckenna Dr, Mountain Home, ID 83647-2143 |
| Justin G Smith | Family Medicine | St Lukes Clinic-treasure Valley LLC | 465 Mckenna Dr, Mountain Home, ID 83647-2143 |
| Elva M Mcnurlin | Registered Dietitian Or Nutrition Professional | St Lukes Regional Medical Center | 465 Mckenna Dr, Mountain Home, ID 83647-2143 |
| Karl H Olson | Family Practice | St Lukes Regional Medical Center | 465 Mckenna Dr, Mountain Home, ID 83647-2143 |
| Megan M Sandmann | Family Medicine | Rural Physicians Group Pannu Pllc | 895 N 6th, Mountain Home, ID 83647-2207 |
| Steven V Marx | Diagnostic Radiology | Boise Radiology Group Pllc | 895 N 6th St E, Mountain Home, ID 83647-2207 |
| Find all physicians in zip 83647 | |||
| City | MOUNTAIN HOME |
| Zip Code | 83647 |
| Specialty | FAMILY MEDICINE |
| City + Specialty | MOUNTAIN HOME + FAMILY MEDICINE |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.