# PORTNEUF MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Portneuf Medical Practices
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750323515
- **Authorized official:** JOHNATHAN WILKER (VP FINANCE & CFO)
- **Authorized official phone:** (208) 239-1020

## Contact information

- **Practice address:** 651 MEMORIAL DR, POCATELLO, ID 83201-4071
- **Practice address phone:** (208) 239-1000
- **Practice address fax:** (208) 239-3741
- **Mailing address:** PO BOX 4168, POCATELLO, ID 83205-4168
- **Mailing address phone:** (208) 239-1000
- **Mailing address fax:** (208) 239-3741

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 282N00000X | General Acute Care Hospital | H12 | ID | Yes |

## Other

- **Enumeration date:** 06/12/2006
- **Last updated:** 06/03/2008