Organization
CARIBOU MEMORIAL HOSPITAL
Active
Other names
LAKEVIEW MEDICAL CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN L HOOPES (CEO)
(208) 547-3341
Entity
Organization
Contact information
Practice address
300 S 3RD W, SODA SPRINGS, ID 83276-1559
(208) 547-3341
(208) 547-2790
Mailing address
300 S 3RD W, SODA SPRINGS, ID 83276-1559
(208) 547-3341
(208) 547-2790
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
37
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806721500
—
ID
01
—
8F975
BLUE CROSS
ID
Enumeration date
06/06/2007
Last updated
12/21/2012
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