Healthcare Provider Details

I. General information

NPI: 1518962273
Provider Name (Legal Business Name): ELMORE MEDICAL CENTER HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 NORTH 6TH EAST
MOUNTAIN HOME ID
83647
US

IV. Provider business mailing address

895 NORTH 6TH EAST
MOUNTAIN HOME ID
83647
US

V. Phone/Fax

Practice location:
  • Phone: 208-587-8401
  • Fax: 208-587-8406
Mailing address:
  • Phone: 208-587-8401
  • Fax: 208-587-8406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number StateID

VIII. Authorized Official

Name: TRICIA SENGER
Title or Position: CFO
Credential:
Phone: 208-587-8401