Healthcare Provider Details

I. General information

NPI: 1922182278
Provider Name (Legal Business Name): STEELE MEMORIAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 04/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 MAIN ST.
SALMON ID
83467
US

IV. Provider business mailing address

805 MAIN ST.
SALMON ID
83467
US

V. Phone/Fax

Practice location:
  • Phone: 208-756-6212
  • Fax: 208-756-6336
Mailing address:
  • Phone: 208-756-6212
  • Fax: 208-756-6336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number133996
License Number StateID

VIII. Authorized Official

Name: ABNER KING
Title or Position: COO
Credential:
Phone: 208-756-5720