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Organization
POCATELLO HOSPITAL LLC
Active
Organization
POCATELLO HOSPITAL LLC
Active
Other names
Portneuf Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN C. PETROVICH (EVP, GENERAL COUNSEL)
(615) 296-3594
Entity
Organization
Contact information
Practice address
777 HOSPITAL WAY, POCATELLO, ID 83201-5175
(208) 239-1000
(208) 239-1934
Mailing address
777 HOSPITAL WAY, POCATELLO, ID 83201-5175
(208) 239-1000
(208) 239-1934
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
12
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
130028
MEDICARE OSCAR
ID
Enumeration date
02/27/2006
Last updated
04/19/2022
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