Pocatello Hospital LLC
Internal Medicine in Pocatello, ID. Organization (NPI-2).
NPI number1760610935
StatusActive
Last updated in NPPESApr 19, 2022
Details
- NPI
- 1760610935
- Entity type
- Organization (NPI-2)
- Legal business name
- Pocatello Hospital LLC
- Organization subpart
- No
- Enumeration date
- Jun 26, 2009
- Certification date
- Apr 19, 2022
- Last updated
- Apr 19, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207R00000X | Internal Medicine | – | – | Yes |
| 282N00000X | General Acute Care Hospital | 12 | ID | |
| 367500000X | Nurse Anesthetist, Certified Registered | – | – |
Practice location
651 Memorial DrPocatello, ID 83201-4071
Phone 208-239-2110 · Fax 208-239-2145
Mailing address
651 Memorial DrPocatello, ID 83201-4071
Phone 208-239-2110 · Fax 208-239-2145
Authorized official
Stephen C. Petrovich
Evp, General Counsel
6152963594
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