Provider Demographics
NPI:1043264021
Name:EASTERN IDAHO HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:EASTERN IDAHO HEALTH SERVICES, INC.
Other - Org Name:EASTERN IDAHO REGIONAL MEDICAL CENTER TRANSITIONAL CARE UNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAIOCCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-529-6111
Mailing Address - Street 1:3100 CHANNING WAY
Mailing Address - Street 2:P.O. BOX 2077
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7533
Mailing Address - Country:US
Mailing Address - Phone:208-529-6111
Mailing Address - Fax:208-529-7021
Practice Address - Street 1:3100 CHANNING WAY
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7533
Practice Address - Country:US
Practice Address - Phone:208-529-6111
Practice Address - Fax:208-529-7021
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EASTERN IDAHO HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-22
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
135115Medicare Oscar/Certification