Healthcare Provider Details

I. General information

NPI: 1104045392
Provider Name (Legal Business Name): SAINT ALPHONSUS REGIONAL MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 W CHERRY LN SUITE D
MERIDIAN ID
83642
US

IV. Provider business mailing address

901 N CURTIS RD #204
BOISE ID
83706-1338
US

V. Phone/Fax

Practice location:
  • Phone: 208-367-8593
  • Fax: 208-367-8595
Mailing address:
  • Phone: 208-367-8950
  • Fax: 208-367-6908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateID

VIII. Authorized Official

Name: BRIAN LANNIE CHECKETTS
Title or Position: CFO & BOARD MEMBER
Credential:
Phone: 208-367-2844