1144287756 NPI number — BONNER GENERAL HOSPITAL, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144287756 NPI number — BONNER GENERAL HOSPITAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BONNER GENERAL HOSPITAL, 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:
Provider Other Organization Name Type Code:
6
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:
1144287756
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
520 N 3RD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANDPOINT
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83864-1507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-265-1101
Provider Business Mailing Address Fax Number:
208-265-1277

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 N 3RD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANDPOINT
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83864-1507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-265-1101
Provider Business Practice Location Address Fax Number:
208-265-1277
Provider Enumeration Date:
04/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RICKARD
Authorized Official First Name:
SHERYL
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
208-265-1100

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  22 , 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: 000010004580 . This is a "REGENCE BLUE SHIELD 1500" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 002406400 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000010004581 . This is a "REGENCE BLUE SHIELD 1500" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 002274000 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3300423 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7027337 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000010004582 . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 7106958 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8K388 . This is a "BLUE CROSS 1500" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 000010004583 . This is a "REGENCE BLUE SHIELD UB92" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 0410280 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00067 . This is a "BLUE CROSS UB92" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 0027647 . This is a "DEPT OF LABOR UB92" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0354783 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0146625 . This is a "DEPT OF LABOR 1500" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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