1609046671 NPI number — NORTH CANYON MEDICAL CENTER INC.

Table of content: (NPI 1609046671)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609046671 NPI number — NORTH CANYON MEDICAL CENTER INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH CANYON MEDICAL CENTER INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NORTH CANYON MEDICAL CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609046671
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
267 NORTH CANYON DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GOODING
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-934-4433
Provider Business Mailing Address Fax Number:
208-934-8643

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
267 NORTH CANYON DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GOODING
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83330-1858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-934-4433
Provider Business Practice Location Address Fax Number:
208-934-8643
Provider Enumeration Date:
03/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DEMOE
Authorized Official First Name:
SARA
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
208-934-9695

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  19 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000010166504 . This is a "REGENCE BLUE SHIELD EMERENCY ROOM" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 1609046671 . This is a "NORTH CANYON MEDICAL CENTER" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 805657700 . This is a "MEDICAID LIFELINE" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 000010166495 . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 002856400 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1518377019 . This is a "GOODING FAMILY PHYSICIANS" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 185627500 . This is a "DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1952716540 . This is a "JENNIFER PARSONS" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 614134000 . This is a "DEPARTMENT OF LABOR" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 805694900 . This is a "MEDICAID EMERGENCY ROOM" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 131302 . This is a "MEDICARE" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 808314000 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1252103 . This is a "CIGNA GOVERNMENT" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1285925602 . This is a "JENNIFER OLSEN" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 131302 . This is a "MEDICARE BILLING NUMBER" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




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