# ELMORE MEDICAL CENTER HOSPITAL DISTRICT

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Trinity Mountain Family Practice
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831179696
- **Authorized official:** MR. GREG MAUER (CEO)
- **Authorized official phone:** (208) 580-2677

## Contact information

- **Practice address:** 465 MCKENNA DR, MOUNTAIN HOME, ID 83647-2143
- **Practice address phone:** (208) 587-9703
- **Practice address fax:** (208) 580-9812
- **Mailing address:** 465 MCKENNA DR, MOUNTAIN HOME, ID 83647-2143
- **Mailing address phone:** (208) 587-9703
- **Mailing address fax:** (208) 580-9812

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/18/2006
- **Last updated:** 08/22/2020