Organization
POCATELLO HOSPITAL LLC
Active
Other names
Portneuf Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN C. PETROVICH (EVP, GENERAL COUNSEL)
(615) 296-3594
Entity
Organization
Contact information
Practice address
777 HOSPITAL WAY, POCATELLO, ID 83201-5175
(208) 239-1000
(208) 239-1934
Mailing address
777 HOSPITAL WAY, POCATELLO, ID 83201-5175
(208) 239-1000
(208) 239-1934
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
12
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
130028
MEDICARE OSCAR
ID
Enumeration date
02/27/2006
Last updated
04/19/2022
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