Healthcare Provider Details

I. General information

NPI: 1093810442
Provider Name (Legal Business Name): POWER COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 ROOSEVELT ST
AMERICAN FALLS ID
83211-1362
US

IV. Provider business mailing address

510 ROOSEVELT ST
AMERICAN FLS ID
83211-1362
US

V. Phone/Fax

Practice location:
  • Phone: 208-226-3200
  • Fax: 208-226-3223
Mailing address:
  • Phone: 208-226-3200
  • Fax: 208-226-3223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number25
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State

VIII. Authorized Official

Name: DANELLE REAVES
Title or Position: PATIENT ACCOUNTING SUPERVISOR
Credential:
Phone: 208-226-3200