Organization
MINIDOKA MEMORIAL HOSPITAL CRNA GROUP
Active
Parent organization
MINIDOKA MEMORIAL HOSPITAL
Organization subpart
Yes
Provider details
NPI number
Legal business name
MINIDOKA MEMORIAL HOSPITAL
Authorized official
CARL HANSEN (ADMINISTRATOR)
(208) 436-0481
Entity
Organization
Contact information
Practice address
1224 8TH ST, RUPERT, ID 83350-1527
(208) 436-0481
(208) 434-8675
Mailing address
1224 8TH ST, RUPERT, ID 83350-1527
(208) 436-0481
(208) 434-8675
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00166
BLUE CROSS OF IDAHO
—
01
—
002336000
BLUE SHIELD
—
05
—
M8068633
—
ID
Enumeration date
04/15/2008
Last updated
10/03/2011
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