# MCCALL MEMORIAL HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MCCALL MEMORIAL HOSPITAL
- **Other names:** Donnelly Medical Clinic, a MMH Physician Clinic
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1265564967
- **Legal business name:** MCCALL MEMORIAL HOSPITAL
- **Authorized official:** KAREN J KELLIE (PRESIDENT)
- **Authorized official phone:** (208) 634-2221

## Contact information

- **Practice address:** 454 WEST ROSEBERRY RD, SUITE 103, DONNELLY, ID 83615
- **Practice address phone:** (208) 325-4455
- **Practice address fax:** (208) 325-4466
- **Mailing address:** 1000 STATE ST, MCCALL, ID 83638-3704
- **Mailing address phone:** (208) 634-2221
- **Mailing address fax:** (208) 634-7112

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QC0050X | Critical Access Hospital Clinic/Center | 11 | ID | Yes |

## Other

- **Enumeration date:** 03/09/2007
- **Last updated:** 02/15/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000010159605 | REGENCE CLINIC NUMBER | ID |
| 01 | — | 8M977 | BLUE CROSS OF ID CLINIC | ID |