Healthcare Provider Details

I. General information

NPI: 1528390895
Provider Name (Legal Business Name): EIRMC HOSPITALIST SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2010
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 CHANNING WAY
IDAHO FALLS ID
83404-7533
US

IV. Provider business mailing address

2860 CHANNING WAY SUITE 213
IDAHO FALLS ID
83404-7531
US

V. Phone/Fax

Practice location:
  • Phone: 208-227-2570
  • Fax: 208-227-2571
Mailing address:
  • Phone: 208-227-2570
  • Fax: 208-227-2571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number39651
License Number StateID

VIII. Authorized Official

Name: DR. TONY B GOLDEN
Title or Position: PHYSICIAN
Credential: M.D
Phone: 208-227-2570