Organization
ELMORE MEDICAL CENTER SPECIALTY PHYSICIAN GROUP
Active
Parent organization
ELMORE MEDICAL CENTER HOSPITAL DISTRICT
Organization subpart
Yes
Provider details
NPI number
Legal business name
ELMORE MEDICAL CENTER HOSPITAL DISTRICT
Authorized official
MRS. MARY E JANOUSEK (OFFICE MANAGER)
(208) 587-8401
Entity
Organization
Contact information
Practice address
890 N 6TH E, MOUNTAIN HOME, ID 83647-2206
(208) 587-8401
(208) 587-8406
Mailing address
PO BOX 1270, MOUNTAIN HOME, ID 83647-1270
(208) 587-8401
(208) 587-8406
Taxonomy
Speciality
Code
Description
License number
State
282NC0060X
Critical Access Hospital
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010149755
BLUE SHIELD PROF NUMBER
ID
01
—
000014148578
BLUE SHIELD
ID
05
—
002860700
—
ID
01
—
8K594
BLUE CROSS
ID
Enumeration date
04/25/2008
Last updated
05/28/2009
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