Basic Information
| Provider Information | |||||||||
| NPI: | 1518962273 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ELMORE MEDICAL CENTER HOSPITAL DISTRICT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 895 NORTH 6TH EAST | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | ID | ||||||||
| PostalCode: | 83647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2085878401 | ||||||||
| FaxNumber: | 2085878406 | ||||||||
| Practice Location | |||||||||
| Address1: | 895 NORTH 6TH EAST | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | ID | ||||||||
| PostalCode: | 83647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2085878401 | ||||||||
| FaxNumber: | 2085878406 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | SENGER | ||||||||
| AuthorizedOfficialFirstName: | TRICIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2085878401 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | ID | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 000010148578 | 01 | ID | BLUE SHIELD | OTHER | 002860700 | 05 | ID | MEDICAID | 13Z311 | 01 | ID | MEDICARE SWING BED | OTHER | 8K594 | 01 | ID | BLUE CROSS PROF NUMBER | OTHER | 000010149755 | 01 | ID | BLUE SHIELD PROF NUMBER | OTHER | 00406 | 01 | ID | BLUE CROSS | OTHER | 807044000 | 01 | ID | MEDICAID PROFESSIONAL FEE | OTHER |