Healthcare Provider Details

I. General information

NPI: 1073834529
Provider Name (Legal Business Name): MOUNTAIN VIEW HOSPITAL PHYSICIAN ORGANIZATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 06/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 CORONADO ST
IDAHO FALLS ID
83404
US

IV. Provider business mailing address

2325 CORONADO ST
IDAHO FALLS ID
83404
US

V. Phone/Fax

Practice location:
  • Phone: 208-557-2700
  • Fax: 208-557-2701
Mailing address:
  • Phone: 208-557-2700
  • Fax: 208-557-2701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number64
License Number StateID

VIII. Authorized Official

Name: MS. EVELYN ROSSI
Title or Position: VICE PRESIDENT OF PATIENT FINANACIA
Credential:
Phone: 208-557-2716