Organization
POCATELLO HOSPITAL LLC
Active
Organization
POCATELLO HOSPITAL LLC
Active
Parent organization
PORTNEUF MEDICAL CENTER
Other names
Portneuf Medical Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
PORTNEUF MEDICAL CENTER
Authorized official
STEPHEN C. PETROVICH (EVP GENERAL COUNSEL)
(615) 296-3594
Entity
Organization
Contact information
Practice address
777 HOSPITAL WAY, POCATELLO, ID 83201-5175
(208) 239-1000
(208) 239-2134
Mailing address
777 HOSPITAL WAY, POCATELLO, ID 83201-5175
(208) 239-1000
(208) 239-2134
Taxonomy
Speciality
Code
Description
License number
State
273R00000X
Psychiatric Hospital Unit
Primary
H12
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806570500
—
ID
Enumeration date
06/12/2006
Last updated
04/19/2022
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