Organization
NORTH CANYON MEDICAL CENTER, INC.
Active
Organization
NORTH CANYON MEDICAL CENTER, INC.
Active
Parent organization
NORTH CANYON MEDICAL CENTER, INC.
Other names
North Canyon Family Medicine, North Canyon Family Medicine
Organization subpart
Yes
Provider details
NPI number
Legal business name
NORTH CANYON MEDICAL CENTER, INC.
Authorized official
TIMOTHY POWERS (CHIEF EXECUTIVE OFFICER)
(208) 934-8765
Entity
Organization
Contact information
Practice address
267 N. CANYON DRIVE, GOODING, ID 83330
(208) 934-4446
(208) 934-4442
Mailing address
267 N CANYON DRIVE, MEDICAL PLAZA, GOODING, ID 83330
(208) 934-4446
(208) 934-4442
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
138520
UNSPECIFIED
ID
01
—
1518377019
RHC
ID
01
—
1609046671
NORTH CANYON MEDICAL CENTER
ID
Enumeration date
05/06/2014
Last updated
06/16/2018
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