MEDICARE: SAINT ALPHONSUS REGIONAL MEDICAL CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center	ID
2	261QR0400X	Rehabilitation Clinic/Center	ID
3	261QP2000X	Physical Therapy Clinic/Center	ID

General Provider Information

NPI Number	:	1104045392
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAINT ALPHONSUS REGIONAL MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	901 N CURTIS RD
Second Line	:	#204
City	:	BOISE
State	:	ID
Zip	:	83706-1338
Country	:	US
Telephone Number	:	208-367-8950
Fax Number	:	208-367-6908

Provider Business Practice Location Address
First Line	:	3025 W CHERRY LN
Second Line	:	SUITE D
City	:	MERIDIAN
State	:	ID
Zip	:	83642
Country	:	US
Telephone Number	:	208-367-8593
Fax Number	:	208-367-8595

Authorized Official
Title or Position	:	CFO & BOARD MEMBER
Name	:	BRIAN LANNIE CHECKETTS
Credential	:
Telephone Number	:	208-367-7347

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	03/16/2026

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