Healthcare Provider Details

I. General information

NPI: 1154563963
Provider Name (Legal Business Name): BONNER GENERAL HOSPITAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2009
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N 3RD AVE
SANDPOINT ID
83864-1507
US

IV. Provider business mailing address

PO BOX 1343
SANDPOINT ID
83864-0863
US

V. Phone/Fax

Practice location:
  • Phone: 208-263-1441
  • Fax: 208-265-1277
Mailing address:
  • Phone: 208-265-1158
  • Fax: 208-265-1277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number22
License Number StateID

VIII. Authorized Official

Name: JOHN HENNESSY
Title or Position: CEO
Credential:
Phone: 208-265-1100