Mark G Willis (NPI# 1154838886, PAC ID# 4082974142) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is NURSE PRACTITIONER.
| Nation Provider ID (NPI) | 1154838886 |
| PAC ID by PECOS | 4082974142 |
| Professional Enrollment ID | I20180209000865 |
| Full Name | Mark G Willis |
| Organization Legal Name | OPTIMUM HEALTH LLC |
| Address |
1071 Renee Ave Pocatello ID 83201-2508 |
| Phone Number | 6022736770 |
| Gender | M |
| Graduation Year | 2017 |
| Primary Specialty | NURSE PRACTITIONER |
| Group Practice PAC ID | 1153656590 |
| Number of Group Practice Members | 2 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 130028 | PORTNEUF MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 1071 Renee Ave, Pocatello, ID 83201-2508 | 6022736770 | OPTIMUM HEALTH LLC |
| 527 Memorial Dr, Pocatello, ID 83201-4063 | 6022736770 | OPTIMUM HEALTH LLC |
| 777 Hospital Way, Pocatello, ID 83201-5175 | 4804219700 | ROCKY MOUNTAIN PHYSICIAN GROUP LLC |
| Organization Legal Name | OPTIMUM HEALTH LLC |
| Physicians | 2 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| David L Francis | Emergency Medicine | Optimum Health LLC | 1071 Renee Ave, Pocatello, ID 83201-2508 |
| Street Address |
1071 RENEE AVE |
| City | POCATELLO |
| State | ID |
| Zip | 83201-2508 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| David L Francis | Emergency Medicine | Optimum Health LLC | 1071 Renee Ave, Pocatello, ID 83201-2508 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Timothy A Flicker | Physical Therapy | 2839 Margo Ln, Pocatello, ID 83201-1961 | |
| Michael D Lance | Psychiatry | St Luke's Clinic, LLC | 2001 Bench Rd, Pocatello, ID 83201-2033 |
| Kenneth A Cogen | Nephrology | St Luke's Clinic, LLC | 2001 Bench Rd, Pocatello, ID 83201-2033 |
| Randall J Skeem | Internal Medicine | St Luke's Clinic, LLC | 2001 Bench Rd, Pocatello, ID 83201-2033 |
| Martha Elizabeth Franz | Family Practice | St Luke's Clinic, LLC | 2001 Bench Rd, Pocatello, ID 83201-2033 |
| John L Shuss | General Surgery | St Luke's Clinic, LLC | 2001 Bench Rd, Pocatello, ID 83201-2033 |
| Ciara C Christensen | Clinical Psychologist | St Luke's Clinic, LLC | 2001 Bench Rd, Pocatello, ID 83201-2033 |
| Robin L Hall | Nurse Practitioner | St Luke's Clinic, LLC | 2001 Bench Rd, Pocatello, ID 83201-2033 |
| Laurence L Martens | Family Practice | St Luke's Clinic, LLC | 2001 Bench Rd, Pocatello, ID 83201-2033 |
| Terry J Buccambuso | Diagnostic Radiology | St Luke's Clinic, LLC | 2001 Bench Rd, Pocatello, ID 83201-2033 |
| Find all physicians in zip 83201 | |||
| City | POCATELLO |
| Zip Code | 83201 |
| Specialty | NURSE PRACTITIONER |
| City + Specialty | POCATELLO + NURSE PRACTITIONER |
Please comment or provide details below to improve the information on Mark G Willis.
| 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.