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General NPI Number Information
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NPI Number | 1528125176
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Entity Type | Organization
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Legal Business Name | SALMON RIVER CLINIC HOSPITAL DISTRICT
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 11/21/2012
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Provider Practice Location Address
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Address Line | 1 NIECE AVENUE
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City | STANLEY
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State | ID
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Zip | 83278-0129
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Country | US
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Telephone | 208-774-3565
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Fax | 208-774-3424
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Provider Business Mailing Address
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Address Line | PO BOX 129
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City | STANLEY
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State | ID
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Zip | 83278-0129
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Country | US
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Telephone | 208-774-3565
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Fax | 208-774-3424
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | AMY MERCANTINI KLINGLER
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Credential | PA-C
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Telephone | 208-774-3565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 5510
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License Number State | ID
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