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General NPI Number Information
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NPI Number | 1518377019
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Entity Type | Organization
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Legal Business Name | NORTH CANYON MEDICAL CENTER, INC.
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Dates
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Enumeration Date | 05/06/2014
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 267 N. CANYON DRIVE
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City | GOODING
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State | ID
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Zip | 83330
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Country | US
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Telephone | 208-934-4446
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Fax | 208-934-4442
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Provider Business Mailing Address
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Address Line | 267 N CANYON DRIVE MEDICAL PLAZA
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City | GOODING
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State | ID
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Zip | 83330
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Country | US
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Telephone | 208-934-4446
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Fax | 208-934-4442
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | TIMOTHY POWERS
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Credential |
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Telephone | 208-934-8765
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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