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General NPI Number Information
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NPI Number | 1043215437
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Entity Type | Organization
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Legal Business Name | SHOSHONE MEDICAL CENTER
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Dates
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Enumeration Date | 06/14/2005
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Last Update Date | 04/27/2021
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Provider Practice Location Address
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Address Line | 25 JACOBS GULCH RD
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City | KELLOGG
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State | ID
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Zip | 83837-2023
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Country | US
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Telephone | 208-784-7017
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Fax | 208-786-1019
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Provider Business Mailing Address
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Address Line | 25 JACOBS GULCH RD
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City | KELLOGG
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State | ID
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Zip | 83837-2023
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Country | US
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Telephone | 208-784-7017
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Fax | 208-786-1019
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Authorized Official
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Title or Position | CFO
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Name | MISS DONJA ERDMAN
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Credential |
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Telephone | 208-784-1221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 44
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License Number State | ID
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