Provider Demographics
NPI:1275703241
Name:NORTH CANYON MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:NORTH CANYON MEDICAL CENTER, INC.
Other - Org Name:NORTH CANYON MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-934-4433
Mailing Address - Street 1:267 NORTH CANYON DRIVE
Mailing Address - Street 2:
Mailing Address - City:GOODING
Mailing Address - State:ID
Mailing Address - Zip Code:83330-1858
Mailing Address - Country:US
Mailing Address - Phone:208-934-4433
Mailing Address - Fax:208-934-8643
Practice Address - Street 1:267 NORTH CANYON DRIVE
Practice Address - Street 2:
Practice Address - City:GOODING
Practice Address - State:ID
Practice Address - Zip Code:83330-1858
Practice Address - Country:US
Practice Address - Phone:208-934-4433
Practice Address - Fax:208-934-8643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002857200Medicaid
ID13Z302OtherMEDICARE BILLING NUMBER
ID1275703241Medicaid
ID138520OtherRURAL HEALTH CLINIC
ID002857200Medicaid
ID131302Medicare Oscar/Certification
ID1370131Medicare Oscar/Certification