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General NPI Number Information
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NPI Number | 1336125533
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Entity Type | Organization
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Legal Business Name | BEAR LAKE COUNTY MEMORIAL HOSPITAL
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Dates
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Enumeration Date | 12/20/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 164 S 5TH ST
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City | MONTPELIER
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State | ID
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Zip | 83254-1557
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Country | US
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Telephone | 208-847-1630
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Fax | 208-847-2201
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Provider Business Mailing Address
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Address Line | 164 S 5TH ST
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City | MONTPELIER
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State | ID
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Zip | 83254-1557
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Country | US
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Telephone | 208-847-1630
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Fax | 208-847-2201
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. RODNEY JACOBSON
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Credential |
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Telephone | 208-847-4402
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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 | 35
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License Number State | ID
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