MEDICARE: CARIBOU MEMORIAL HOSPITAL

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	282NC0060X	Critical Access Hospital	37	ID

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
3	86934	OTHER	ID	BLUE CROSS PHYSICIAN
4	00042	OTHER	ID	BLUE CROSS OF IDAHO
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912998261
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARIBOU MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	300 S 3RD W
Second Line	:
City	:	SODA SPRINGS
State	:	ID
Zip	:	83276-1559
Country	:	US
Telephone Number	:	208-547-3341
Fax Number	:	208-547-2790

Provider Business Practice Location Address
First Line	:	300 S 3RD W
Second Line	:
City	:	SODA SPRINGS
State	:	ID
Zip	:	83276-1559
Country	:	US
Telephone Number	:	208-547-3341
Fax Number	:	208-547-2790

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICE
Name	:	JOHN HOOPES
Credential	:
Telephone Number	:	208-547-3341

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	08/09/2013

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Directions to “CARIBOU MEMORIAL HOSPITAL ” Practice Location

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