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General NPI Number Information
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NPI Number | 1851371959
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Entity Type | Organization
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Legal Business Name | MOUNTAIN RIVER BIRTHING AND SURGERY CENTER LLC
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Dates
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Enumeration Date | 01/17/2006
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Last Update Date | 12/16/2019
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Provider Practice Location Address
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Address Line | 350 N MERIDIAN ST
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City | BLACKFOOT
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State | ID
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Zip | 83221-1625
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Country | US
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Telephone | 208-782-0300
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Fax |
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Provider Business Mailing Address
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Address Line | 350 N MERIDIAN ST
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City | BLACKFOOT
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State | ID
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Zip | 83221-1625
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Country | US
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Telephone | 208-782-0300
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JACOB ERICKSON
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Credential |
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Telephone | 208-785-3801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number |
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License Number State |
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