=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669493417
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ST. MARY'S HOSPITAL, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2006
-----------------------------------------------------
Last Update Date | 10/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 701 LEWISTON ST
-----------------------------------------------------
City | COTTONWOOD
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-962-3251
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 701 LEWISTON ST
-----------------------------------------------------
City | COTTONWOOD
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83522-9750
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-962-2301
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | LENNE BONNER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 208-476-4555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 275N00000X
-----------------------------------------------------
Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
-----------------------------------------------------
License Number | 33
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------