1750336608 NPI number — SYRINGA GENERAL HOSPITAL DISTRICT CIF

Table of content: (NPI 1750336608)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750336608 NPI number — SYRINGA GENERAL HOSPITAL DISTRICT CIF

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SYRINGA GENERAL HOSPITAL DISTRICT CIF
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:
Provider Other Organization Name Type Code:
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:
1750336608
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
607 W MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRANGEVILLE
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83530-1345
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-983-1700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
607 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANGEVILLE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83530-1345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-983-1700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WATSON
Authorized Official First Name:
BETTY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
208-983-1700

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  18 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3416L0300X , with the licence number: 7208 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000010006515 . This is a "REGENCE BLUE SHIELD OF ID" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 00299 . This is a "BLUE CROSS OF IDAHO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 002438100 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 83642 . This is a "PRO FEE BLUE CROSS OF ID" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com