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General NPI Number Information
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NPI Number | 1609046671
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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 | 03/06/2008
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Last Update Date | 03/02/2022
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Provider Practice Location Address
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Address Line | 267 NORTH CANYON DRIVE
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City | GOODING
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State | ID
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Zip | 83330-1858
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Country | US
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Telephone | 208-934-4433
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Fax | 208-934-8643
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Provider Business Mailing Address
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Address Line | 267 NORTH 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 | 208-934-4433
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Fax | 208-934-8643
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Authorized Official
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Title or Position | CONTROLLER
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Name | SARA DEMOE
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Credential |
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Telephone | 208-934-9695
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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 | 19
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License Number State | ID
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