MEDICARE: SAINT ALPHONSUS MEDICAL CENTER- ONTARIO INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	213E00000X	Podiatrist
2	207Y00000X	Otolaryngology Physician
3	207V00000X	Obstetrics & Gynecology Physician
4	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093034159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAINT ALPHONSUS MEDICAL CENTER- ONTARIO INC

Provider Business Mailing Address
First Line	:	PO BOX 190930
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83719-0930
Country	:	US
Telephone Number	:	208-367-5170
Fax Number	:	208-367-5180

Provider Business Practice Location Address
First Line	:	1050 SW 3RD AVE
Second Line	:	STE 3200
City	:	ONTARIO
State	:	OR
Zip	:	97914-2193
Country	:	US
Telephone Number	:	541-881-7370
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	BRIAN LANNIE CHECKETTS
Credential	:
Telephone Number	:	208-367-7347

Provider Enumeration Date	:	05/27/2010
Last Update Date	:	03/02/2026

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Directions to “SAINT ALPHONSUS MEDICAL CENTER- ONTARIO INC ” Practice Location

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