Pocatello Hospital LLC
General Acute Care Hospital in Pocatello, ID. Organization (NPI-2).
NPI number1790751055
StatusActive
Last updated in NPPESApr 19, 2022
Details
- NPI
- 1790751055
- Entity type
- Organization (NPI-2)
- Legal business name
- Pocatello Hospital LLC
- Organization subpart
- No
- Enumeration date
- Feb 27, 2006
- Certification date
- Apr 19, 2022
- Last updated
- Apr 19, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 282N00000X | General Acute Care Hospital | 12 | ID | Yes |
Other names
- Portneuf Medical Center (Doing Business As)
Practice location
777 Hospital WayPocatello, ID 83201-5175
Phone 208-239-1000 · Fax 208-239-1934
Mailing address
777 Hospital WayPocatello, ID 83201-5175
Phone 208-239-1000 · Fax 208-239-1934
Authorized official
Stephen C. Petrovich
Evp, General Counsel
6152963594
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