Healthcare Provider Details

I. General information

NPI: 1750336608
Provider Name (Legal Business Name): SYRINGA GENERAL HOSPITAL DISTRICT C I F
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 07/13/2024
Certification Date: 07/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 W MAIN ST
GRANGEVILLE ID
83530-1345
US

IV. Provider business mailing address

607 W MAIN ST
GRANGEVILLE ID
83530-1345
US

V. Phone/Fax

Practice location:
  • Phone: 208-983-1700
  • Fax:
Mailing address:
  • Phone: 208-983-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number7208
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number18
License Number StateID

VIII. Authorized Official

Name: DAVID PAUL APPLEWOOD
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 208-983-1700