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Organization
MOUNTAIN RIVER BIRTHING AND SURGERY CENTER LLC
Active
Organization
MOUNTAIN RIVER BIRTHING AND SURGERY CENTER LLC
Active
Other names
Idaho Doctors Hospital, Grove Creek Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB ERICKSON (CEO)
(208) 785-3801
Entity
Organization
Contact information
Practice address
350 N MERIDIAN ST, BLACKFOOT, ID 83221-1625
(208) 782-0300
Mailing address
350 N MERIDIAN ST, BLACKFOOT, ID 83221-1625
(208) 782-0300
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010147223
BLUE SHIELD PROVIDER #
ID
01
—
04630
BLUE CROSS PROVIDER #
ID
05
—
806958900
—
ID
Enumeration date
01/17/2006
Last updated
12/16/2019
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