1780759068 NPI number — UHS OF KOOTENAU RIVER INC

Table of content: (NPI 1780759068)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780759068 NPI number — UHS OF KOOTENAU RIVER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UHS OF KOOTENAU RIVER 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:
NORTHWEST ACADEMY
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:
1780759068
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1350 E 750 N
Provider Second Line Business Mailing Address:
CENTRAL BUSINESS OFFICE
Provider Business Mailing Address City Name:
OREM
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84097-4345
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-227-2100
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
RR 1 BOX 511
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BONNERS FERRY
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83805-9769
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-227-2100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/21/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FILTON
Authorized Official First Name:
STEVE
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO SR VP
Authorized Official Telephone Number:
610-768-3300

Provider Taxonomy Codes

  • Taxonomy code: 323P00000X , with the licence number:  18322 , 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)