Healthcare Provider Details

I. General information

NPI: 1134173115
Provider Name (Legal Business Name): EASTERN IDAHO HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 06/11/2010
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

3100 CHANNING WAY P.O. BOX 2077
IDAHO FALLS ID
83404-7533
US

V. Phone/Fax

Practice location:
  • Phone: 208-529-6111
  • Fax: 208-529-7021
Mailing address:
  • Phone: 208-529-6111
  • Fax: 208-529-7021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JEFFREY BAIOCCO
Title or Position: CFO
Credential:
Phone: 208-529-6111