Healthcare Provider Details

I. General information

NPI: 1881876886
Provider Name (Legal Business Name): SAINT ALPHONSUS REGIONAL MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2007
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 E RIVERSIDE DR STE 124
EAGLE ID
83616
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 208-367-5400
  • Fax: 208-367-5401
Mailing address:
  • Phone: 208-367-3315
  • Fax: 208-367-2674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: BRIAN LANNIE CHECKETTS
Title or Position: CFO
Credential:
Phone: 208-367-7347