Healthcare Provider Details

I. General information

NPI: 1457414948
Provider Name (Legal Business Name): SAINT ALPHONSUS REGIONAL MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N CURTIS RD #204
BOISE ID
83706
US

IV. Provider business mailing address

901 N CURTIS RD #204
BOISE ID
83706-1338
US

V. Phone/Fax

Practice location:
  • Phone: 208-367-3315
  • Fax: 208-367-2674
Mailing address:
  • Phone: 208-367-6934
  • Fax: 208-367-6908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: BRIAN LANNIE CHECKETTS
Title or Position: CFO
Credential:
Phone: 208-367-2844