Tyler Douglas Clark (NPI# 1124414305, PAC ID# 0749592582) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is FAMILY MEDICINE.
| Nation Provider ID (NPI) | 1124414305 |
| PAC ID by PECOS | 0749592582 |
| Professional Enrollment ID | I20181102001987 |
| Full Name | Tyler Douglas Clark |
| Organization Legal Name | ST JOSEPH HOSPITAL LLC |
| Address |
307 Saint Johns Way Suite 11 Lewiston ID 83501-2435 |
| Phone Number | 2087503832 |
| Gender | M |
| Graduation Year | 2015 |
| Primary Specialty | FAMILY MEDICINE |
| Group Practice PAC ID | 8325325806 |
| Number of Group Practice Members | 70 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 130003 | ST JOSEPH REGIONAL MEDICAL CENTER |
| 501332 | TRI-STATE MEMORIAL HOSPITAL |
| 131320 | CLEARWATER VALLEY HOSPITAL & CLINICS |
| Address | Phone | Organization |
|---|---|---|
| 307 Saint Johns Way, Suite 11, Lewiston, ID 83501-2435 | 2087503832 | ST JOSEPH HOSPITAL LLC |
| Organization Legal Name | ST JOSEPH HOSPITAL LLC |
| Physicians | 61 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Kyle James Daly | Certified Registered Nurse Anesthetist (crna) | St Joseph Hospital LLC | 415 6th St, Lewiston, ID 83501-2431 |
| Clinton R Morgan | Hematology/oncology | St Joseph Hospital LLC | 1250 Idaho St, Lewiston, ID 83501-1965 |
| Barry Smith | General Surgery | St Joseph Hospital LLC | 307 Saint Johns Way, Suite 4, Lewiston, ID 83501-2435 |
| Barbara K Davis | Internal Medicine | St Joseph Hospital LLC | 222 Southway Ave, Suite C, Lewiston, ID 83501-2703 |
| David B Souvenir | Infectious Disease | St Joseph Hospital LLC | 415 6th St, Lewiston, ID 83501-2431 |
| Lori Beth Bennett-penn | Psychiatry | St Joseph Hospital LLC | 415 6th St, Lewiston, ID 83501-2431 |
| Matthew George Krahn | Certified Registered Nurse Anesthetist (crna) | St Joseph Hospital LLC | 415 6th St, Lewiston, ID 83501-2431 |
| Amy Dawnette Johnson | Nurse Practitioner | St Joseph Hospital LLC | 307 Saint Johns Way, Suite 17, Lewiston, ID 83501-2435 |
| Donald J Greggain | Family Medicine | St Joseph Hospital LLC | 307 Saint Johns Way, Lewiston, ID 83501-2435 |
| William Westel Rowe | Interventional Cardiology | St Joseph Hospital LLC | 415 6th St, Lewiston, ID 83501-2431 |
| Street Address |
307 SAINT JOHNS WAY SUITE 11 |
| City | LEWISTON |
| State | ID |
| Zip | 83501-2435 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Barry Smith | General Surgery | St Joseph Hospital LLC | 307 Saint Johns Way, Suite 4, Lewiston, ID 83501-2435 |
| Amy Dawnette Johnson | Nurse Practitioner | St Joseph Hospital LLC | 307 Saint Johns Way, Suite 17, Lewiston, ID 83501-2435 |
| Donald J Greggain | Family Medicine | St Joseph Hospital LLC | 307 Saint Johns Way, Lewiston, ID 83501-2435 |
| Mark R Keane | Neurology | St Joseph Hospital LLC | 307 Saint Johns Way, Suite 1, Lewiston, ID 83501-2435 |
| Tamara L Bruns | Nurse Practitioner | St Joseph Hospital LLC | 307 Saint Johns Way, Lewiston, ID 83501-2435 |
| Michael J Baldeck | Family Medicine | St Joseph Hospital LLC | 307 Saint Johns Way, Lewiston, ID 83501-2435 |
| Daniel B Mcintosh | Internal Medicine | St Joseph Hospital LLC | 307 Saint Johns Way, Suite 17, Lewiston, ID 83501-2435 |
| Jean K Thomas | Neurosurgery | St Joseph Hospital LLC | 307 Saint Johns Way, Suite 1, Lewiston, ID 83501-2435 |
| Gary M Thorne | General Surgery | St Joseph Hospital LLC | 307 Saint Johns Way, Suite 4, Lewiston, ID 83501-2435 |
| Larry D Harries | Family Practice | St Joseph Regional Medical Center | 307 Saint Johns Way, Lewiston, ID 83501-2435 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Lori L Holder | Clinical Social Worker | 504 Main St, Suite 472, Lewiston, ID 83501-1806 | |
| Thomas R Boyer | Chiropractic | 717 D St, Lewiston, ID 83501-1826 | |
| Rebecca A Bohnenkamp | Clinical Social Worker | 523 /2 Main St, Suite 7, Lewiston, ID 83501-1870 | |
| Kristy Anne Kuehfuss | Psychologist, Clinical | 633 Main St, Suite B2, Lewiston, ID 83501-1882 | |
| Clinton R Morgan | Hematology/oncology | St Joseph Hospital LLC | 1250 Idaho St, Lewiston, ID 83501-1965 |
| Alice Myra Forsythe | Medical Oncology | St Joseph Hospital LLC | 1250 Idaho St, Lewiston, ID 83501-1965 |
| John Siebel | Hematology/oncology | St Joseph Hospital LLC | 1250 Idaho St, Lewiston, ID 83501-1965 |
| Michele R Dickison | Nurse Practitioner | St Joseph Hospital LLC | 1250 Idaho St, Lewiston, ID 83501-1965 |
| Debra L Street | Clinical Social Worker | 0309 2nd St, Lewiston, ID 83501-2163 | |
| Mark F Yama | Psychologist, Clinical | 428 6th Ave, Lewiston, ID 83501-2355 | |
| Find all physicians in zip 83501 | |||
| City | LEWISTON |
| Zip Code | 83501 |
| Specialty | FAMILY MEDICINE |
| City + Specialty | LEWISTON + FAMILY MEDICINE |
Please comment or provide details below to improve the information on Tyler Douglas Clark.
| 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.