Organization
SHOSHONE MEDICAL CENTER
Active
Parent organization
SHOSHONE MEDICAL CENTER
Organization subpart
Yes
Provider details
NPI number
Legal business name
SHOSHONE MEDICAL CENTER
Authorized official
DONJA C ERDMAN (CFO)
(208) 784-1221
Entity
Organization
Contact information
Practice address
25 JACOBS GULCH RD, KELLOGG, ID 83837-2023
(208) 784-4612
(208) 786-1019
Mailing address
25 JACOBS GULCH RD, KELLOGG, ID 83837-2023
(208) 784-1228
(208) 786-1019
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
07/07/2020
Last updated
04/27/2021
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