MEDICARE: HOSPICE OF EASTERN IDAHO, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician
2	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician
3	251G00000X	Community Based Hospice Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407859721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOSPICE OF EASTERN IDAHO, INC.

Provider Business Mailing Address
First Line	:	1810 MORAN ST.
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83401
Country	:	US
Telephone Number	:	208-529-0342
Fax Number	:	208-529-6981

Provider Business Practice Location Address
First Line	:	1810 MORAN ST.
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83401
Country	:	US
Telephone Number	:	208-529-0342
Fax Number	:	208-529-6981

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	CELESTE ELD
Credential	:
Telephone Number	:	208-529-0342

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	06/03/2024

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Directions to “HOSPICE OF EASTERN IDAHO, INC. ” Practice Location

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