Organization
ST. JOSEPH REGIONAL MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBURN (DIRECTOR OF BUSINESS SERVICES)
(208) 799-5200
Entity
Organization
Contact information
Practice address
415 6TH ST, LEWISTON, ID 83501-2431
(208) 743-2511
(208) 799-5554
Mailing address
415 6TH ST, LEWISTON, ID 83501-2431
(208) 743-2511
(208) 799-5554
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
ID
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
—
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010033840
REGENCE OF ID DME
ID
05
—
002271500
—
ID
05
—
6009633
—
WA
01
—
8E365
BLUE CROSS OF ID DME
ID
Enumeration date
02/06/2007
Last updated
05/07/2012
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