Basic Information
| Provider Information | |||||||||
| NPI: | 1689802852 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | POCATELLO HEALTH SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 651 MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | POCATELLO | ||||||||
| State: | ID | ||||||||
| PostalCode: | 832014071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082392110 | ||||||||
| FaxNumber: | 2082392145 | ||||||||
| Practice Location | |||||||||
| Address1: | 651 MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | POCATELLO | ||||||||
| State: | ID | ||||||||
| PostalCode: | 832014071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082392110 | ||||||||
| FaxNumber: | 2082392145 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2009 | ||||||||
| LastUpdateDate: | 06/26/2009 | ||||||||
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| AuthorizedOfficialLastName: | WILKER | ||||||||
| AuthorizedOfficialFirstName: | JONATHAN | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | VP FINANCE & CFO | ||||||||
| AuthorizedOfficialTelephone: | 2082391000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 12 | ID | Y | Hospitals | General Acute Care Hospital |
No ID Information.