# EAGLE ROCK MEDICAL CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083372890
- **Authorized official:** KENDON HOWARD (CEO)
- **Authorized official phone:** (208) 972-0420

## Contact information

- **Practice address:** 919 S UTAH AVE, IDAHO FALLS, ID 83402-3322
- **Practice address phone:** (208) 425-6020
- **Mailing address:** 919 S UTAH AVE, IDAHO FALLS, ID 83402-3322
- **Mailing address phone:** (208) 425-6020

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/30/2021
- **Last updated:** 03/21/2022