Healthcare Provider Details

I. General information

NPI: 1295769537
Provider Name (Legal Business Name): GOODING COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 12/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 MONTANA ST
GOODING ID
83330-1858
US

IV. Provider business mailing address

1120 MONTANA ST PO BOX 418
GOODING ID
83330-1858
US

V. Phone/Fax

Practice location:
  • Phone: 208-934-4433
  • Fax: 208-934-8643
Mailing address:
  • Phone: 208-934-4433
  • Fax: 208-934-8643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number19
License Number StateID

VIII. Authorized Official

Name: EARL EMMERT FITZPATRICK
Title or Position: CEO
Credential:
Phone: 208-934-4433