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General NPI Number Information
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NPI Number | 1245433739
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Entity Type | Organization
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Legal Business Name | ST. MARY'S HOSPITAL INC
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 08/10/2026
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Provider Practice Location Address
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Address Line | 701 LEWISTON ST
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City | COTTONWOOD
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State | ID
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Zip | 83522
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Country | US
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Telephone | 208-962-3251
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Fax |
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Provider Business Mailing Address
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Address Line | 701 LEWISTON ST
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City | COTTONWOOD
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State | ID
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Zip | 83522-9750
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Country | US
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Telephone | 208-962-3251
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Fax | 208-962-3722
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Authorized Official
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Title or Position | CEO
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Name | LENNE BONNER
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Credential |
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Telephone | 208-476-8008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 33
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License Number State | ID
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