Organization
MINIDOKA MEMORIAL HOSPITAL AMBULANCE
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
3416L0300X
Land Ambulance
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7808
BLUE SHIELD OF IDAHO
—
01
—
E0922
BLUE CROSS OF IDAHO
—
05
—
M0023360
—
ID
Enumeration date
04/15/2008
Last updated
06/07/2011
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