Organization
POCATELLO HOSPITAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN C. PETROVICH (EVP, GENERAL COUNSEL)
(615) 296-3594
Entity
Organization
Contact information
Practice address
651 MEMORIAL DR, POCATELLO, ID 83201-4071
(208) 239-2110
(208) 239-2145
Mailing address
651 MEMORIAL DR, POCATELLO, ID 83201-4071
(208) 239-2110
(208) 239-2145
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
282N00000X
General Acute Care Hospital
12
ID
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Enumeration date
06/26/2009
Last updated
04/19/2022
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