Healthcare Provider Details

I. General information

NPI: 1942364070
Provider Name (Legal Business Name): MINIDOKA MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 8TH ST
RUPERT ID
83350-1527
US

IV. Provider business mailing address

1224 8TH ST
RUPERT ID
83350-1527
US

V. Phone/Fax

Practice location:
  • Phone: 208-436-0481
  • Fax: 208-436-6038
Mailing address:
  • Phone: 208-436-0481
  • Fax: 208-436-6038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number379HP
License Number StateID

VIII. Authorized Official

Name: THOMAS J MURPHY
Title or Position: ADMINISTRATOR
Credential:
Phone: 208-436-8141