1144673021 NPI number — SAINT ALPHONSUS REGIONAL MEDICAL CENTER

Table of content: (NPI 1144673021)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144673021 NPI number — SAINT ALPHONSUS REGIONAL MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAINT ALPHONSUS REGIONAL MEDICAL CENTER
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:
SAMG OCC MED ROSTER BILLING
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:
1144673021
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6533 W EMERALD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOISE
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83704-8737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-302-7600
Provider Business Mailing Address Fax Number:
208-302-7605

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6533 W EMERALD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOISE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83704-8737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-302-7600
Provider Business Practice Location Address Fax Number:
208-302-7605
Provider Enumeration Date:
07/15/2016

Additional Information

Authorized Official

Authorized Official Last Name:
CHECKETTS
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
LANNIE
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
208-367-7347

Provider Taxonomy Codes

  • Taxonomy code: 2083P0500X , with the licence number:  M-5535 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2083X0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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