Organization
SHOSHONE MEDICAL CENTER
Active
Other names
WEST SHOSHONE HOSPITAL DISTRICT
Organization subpart
No
Provider details
NPI number
Authorized official
MISS DONJA ERDMAN (CFO)
(208) 784-1221
Entity
Organization
Contact information
Practice address
25 JACOBS GULCH RD, KELLOGG, ID 83837-2023
(208) 784-7017
(208) 786-1019
Mailing address
25 JACOBS GULCH RD, KELLOGG, ID 83837-2023
(208) 784-7017
(208) 786-1019
Taxonomy
Speciality
Code
Description
License number
State
282NC0060X
Critical Access Hospital
Primary
44
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010000167
REGENCE
ID
05
—
002861700
—
ID
05
—
002861800
—
ID
05
—
002862700
—
ID
01
—
00513
BLUE CROSS OF IDAHO
ID
01
—
0082553
WASHINGTON L & I
—
01
—
10004
WASHINGTON L & I
—
01
—
3016300
WASHINGTON MEDICAID
—
01
—
3504605
MONTANA MEDICAID
—
01
—
411320
MONTANA MEDICAID
—
01
—
7043250
WASHINGTON MEDICAID
—
01
—
86405
BLUE CROSS OF IDAHO
ID
Enumeration date
06/14/2005
Last updated
04/27/2021
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