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General NPI Number Information
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NPI Number | 1659419570
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Entity Type | Organization
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Legal Business Name | ST. ALPHONSUS REGIONAL MEDICAL CENTER INC
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 6138 W EMERALD ST
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City | BOISE
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State | ID
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Zip | 83704-8857
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Country | US
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Telephone | 208-367-3069
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Fax | 208-367-3002
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Provider Business Mailing Address
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Address Line | PO BOX 190930
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City | BOISE
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State | ID
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Zip | 83719-0930
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Country | US
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Telephone | 208-367-3069
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Fax | 208-367-3002
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Authorized Official
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Title or Position | CFO
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Name | BRIAN LANNIE CHECKETTS
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Credential |
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Telephone | 208-367-7347
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State | ID
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