Healthcare Provider Details

I. General information

NPI: 1326241159
Provider Name (Legal Business Name): CLEARWATER VALLEY HOSPITAL & CLINICS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 CEDAR ST
OROFINO ID
83544-9029
US

IV. Provider business mailing address

301 CEDAR ST
OROFINO ID
83544-9029
US

V. Phone/Fax

Practice location:
  • Phone: 208-476-4555
  • Fax: 208-476-5385
Mailing address:
  • Phone: 208-476-4555
  • Fax: 208-476-5385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number01
License Number StateID

VIII. Authorized Official

Name: LINDA M MEACHAM
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 208-476-4555