MEDICARE: ELMORE MEDICAL CENTER HOSPITAL DISTRICT

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1831179696
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELMORE MEDICAL CENTER HOSPITAL DISTRICT

Provider Business Mailing Address
First Line	:	465 MCKENNA DR
Second Line	:
City	:	MOUNTAIN HOME
State	:	ID
Zip	:	83647-2143
Country	:	US
Telephone Number	:	208-587-9703
Fax Number	:	208-580-9812

Provider Business Practice Location Address
First Line	:	465 MCKENNA DR
Second Line	:
City	:	MOUNTAIN HOME
State	:	ID
Zip	:	83647-2143
Country	:	US
Telephone Number	:	208-587-9703
Fax Number	:	208-580-9812

Authorized Official
Title or Position	:	CEO
Name	:	MR. GREG MAUER
Credential	:
Telephone Number	:	208-580-2677

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	08/22/2020

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