Healthcare Provider Details

I. General information

NPI: 1083796569
Provider Name (Legal Business Name): SALMON RIVER CLINIC HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 NIECE AVENUE
STANLEY ID
83278-0129
US

IV. Provider business mailing address

PO BOX 129
STANLEY ID
83278-0129
US

V. Phone/Fax

Practice location:
  • Phone: 208-774-3565
  • Fax:
Mailing address:
  • Phone: 208-774-3565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM-4162
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-492
License Number StateID

VIII. Authorized Official

Name: AMY MERCANTINI KLINGLER
Title or Position: PA/ADMINISTRATOR
Credential: PA-C
Phone: 208-774-3565