Healthcare Provider Details

I. General information

NPI: 1801086012
Provider Name (Legal Business Name): CARIBOU MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SOUTH 3RD WEST
SODA SPRINGS ID
83276
US

IV. Provider business mailing address

300 SOUTH 3RD WEST
SODA SPRINGS ID
83276
US

V. Phone/Fax

Practice location:
  • Phone: 208-547-3341
  • Fax: 208-547-2790
Mailing address:
  • Phone: 208-547-3341
  • Fax: 208-547-2790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: KENT LOOSLE
Title or Position: CEO
Credential:
Phone: 208-547-3341